CASEY GRANT SHUPE DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053410

License Status

CANCELLED

Business

First Name

CASEY

Middle

GRANT

Last Name

SHUPE

Suffix

Business Name

CASEY GRANT SHUPE DO

Original Issue Date

07/01/2007

Effective Date

07/01/2007

Expiration Date

06/30/2010

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

05/15/2007