SHANE DAVID BUSH MD - Medical Doctor License in Illinois | # 125058884

SHANE DAVID BUSH MD

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058884

License Status

CANCELLED

Business

N

Title

MD

First Name

SHANE

Middle

DAVID

Last Name

BUSH

Business Name

SHANE DAVID BUSH MD

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

06/14/2010