SUPARNA T SHIVASHANKARA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036141936

License Status

NOT RENEWED

Business

Title

First Name

SUPARNA

Middle

Last Name

SHIVASHANKARA

Business Name

SUPARNA T SHIVASHANKARA MD

Original Issue Date

11/01/2016

Effective Date

11/01/2016

Expiration Date

07/31/2017

City

PEORIA

State

Zip

61615

County

PEORIA

Ever Disciplined

LastModifiedDate

11/01/2017