SHELBY J BENNETT MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057746

License Status

CANCELLED

Business

Title

First Name

SHELBY

Middle

Last Name

BENNETT

Business Name

SHELBY J BENNETT MD

Original Issue Date

07/01/2011

Effective Date

07/01/2011

Expiration Date

06/30/2013

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

03/08/2011