SHANTI PORTIA GANESH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125050793

License Status

CANCELLED

Business

First Name

SHANTI

Middle

PORTIA

Last Name

GANESH

Suffix

Business Name

SHANTI PORTIA GANESH MD

Original Issue Date

06/19/2006

Effective Date

06/19/2006

Expiration Date

06/18/2009

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

05/25/2010