Application for Renewal Of Registration   with the
Maharashtra Medical Council, Mumbai
Application No :  MMC202235954 Date : 10/02/2022
To,
Registrar ,
Maharashtra Medical Council ,
189/A, Anand Complex, 2nd Floor,
Sane Guruji Marg, Arthur Road Naka,
Chinchpokali (W), Mumbai - 400 011.
 
Sub: Dr  (Smt/Shri)  BAHETI SUSHIL NANDLAL
Registration No:  55605   Registration Date : 16/01/1986   Valid upto Date :28/02/2027
Sir,
I the undersigned applicant, request yoy that my name may be continued on the Register of Medical Practitioners maintained by the Maharashtra Medical Council as per 23 (a)/23 (c) of MMC Act 1965 and amendment 2003. My particulars are as Follows :
Name of Applicant : Mr. BAHETI SUSHIL NANDLAL
Name of Father : Mr.
Name of Mother : Mrs.
In Case of Married Women
Maiden Name : -

RESEDENTIAL ADDRESS : F-123 , PREM NAGAR CHS KOPARI , TAL - DIST- THANE ,
City : THANE District : THANE
State : MAHARASHTRA Country : INDIA
Pincode : 400603
Date of birth : 22/02/1962 Tel No (Res) : Clinic No :
Mobile No : 9769450055 Email Id : sbaheti1962@gmail.com  
Total Obtained Credits Points : 31
Remaining Credits Points : 0
Qualification Details
 Details of QualificationName of CollegeUniversityPassing YearCertificate NoCertificate Date
1.M.B.B.S.GOVERNMENT MEDICAL COLLEGE, NAGPURNAGPUR UNIVERSITY1986  
2.Dip. Child HealthGOVERNMENT MEDICAL COLLEGE, NAGPURNAGPUR UNIVERSITY19891331706/11/1998
Pariticulars Of Payment
Payment Mode : Online Payment
Receipt No : 202206087662629
Receipt Date : 02/03/2022
   I have uploaded following documents:
1.Latest Passport size Photograph
DECLARATION (Registered Medical Practitioner)
I shall abide by the Code of medical Ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002.
Date : 10/02/2022
    Applicant signature               


NOTE:- You do not need to submit the print out of original submitted Renewal Application form to MMC office.