MCIM Renewal Information of Registration No : I70874A

Reference No : MTR_2168

Registration No : 70874

Date: 2019-04-06 13:45:21

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Personal Details

ATUL DNYANDEO
Name Gender Male
SANAP

Date Of Birth 09-May-1986 Place of Birth HIWARSINGA

DNYANDEO
Father's Name Mother Name MANGAL
KACHARU SANAP

VARSHA ATUL
Spouse's Name Blood Group A +ve
SANAP

PAN Card
Aadhar Number 778316584210 EOLPS6513D
Number

Contact Details

Alternate
Mobile Number Link
9403330067 Mobile Number 7721001869
With Aadhar
1

Alternate Mobile Landline

8788585238
Number 2 Number

Alternate Email
Email Id sanap067@gmail.com vasanap067@gmail.com
Id

Contact Address Details

Address AT.HIWARSINGA TA. SHIRUR KA. DIST. BEED,

Area City BEED

Taluka Shirur District Beed

State MAHARASHTRA Pincode 414205

Qualification Details
Page: 1
 Registration
Registration Number 70874 Certificate 07431
Serial No

Date Of
Schedule A 31-July-2012
Registartion

Qualification(Specified
in Second,Third &
Fourth Schedule to Year Of
B.A.M.S. 2011
the Indian Medicine Passing
Central Council
Act,1970)

Year Of Degree
2012 Faculty Ayurveda
Awarded

Maharashtra
Name Of the Name Of the Government Ayurved
University of Health
University College/Institute College,Vazirabad,Nanded
Sciences, Nashik

Name Of SSC
Passing year Of SSC 2002 Maharashtra State Board
Board

Name Of HSC
Passing year Of HSC 2004 Maharashtra State Board
Board

New Additional Qualification Details

State From
Which
Qualification M.D Additional MAHARASHTRA
Degree/Diploma
Obtained

Loknete Rajarambapu
Maharashtra Patil Ayurved Medical
Name of the Name Of
University of Health college, hospital,P.G.
university Institute/College
Sciences, Nashik institute and research
centre, urun islampur

Subject / Rasa Shastra evam Year Of

2015
Specialisation Bhaishajya Kalpana Passing

Occupation Details

Practitioner Details

Practitioner
Practitioner Address Practitioner Mode Practitioner Type
System

Page: 2
MAULI CLINIC NEAR
GRAMSEVAK
Own Integrated Daily
COLONY BALEPIR
NAGER ROAD BEED

Teacher Details

Teacher
CCIM Teacher Code AYURB1339 AYURVEDA
Faculty

RASA SHASTRA &

Department BHAISAJYA State MAHARASHTRA
KALPANA

Maharashtra Dr. Vedprakash Patil

Name Of the Name Of the
University of Health Ayurved College &
University College
Sciences, Nashik Research Institue, Jalna

Assistant Professor(
Designation
Lecturer )

I, solemnly confirm that if any information provided by me is found false, I shall be held
responsible in the matter. I shall have no objection if any action is taken by the MCIM against me.

Date :

Signature :

Page: 3