Indiana
Professional Licensing Agency
Venkatachala N. Vitalpur
Controlled Substance Registration - Physician
License number
01029983B
Date granted
06/18/2004
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
2431 Barcroft Ct., Fort Wayne IN 46804
indianalicensing.org
ID 5854676
LAST UPDATED 2024-03-11 20:19:07 UTC
LAST UPDATED 2024-03-11 20:19:07 UTC
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