SHANE BAVANTRAI MANDALIA DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067263

License Status

EXPIRED

Business

Title

First Name

SHANE

Middle

BAVANTRAI

Last Name

MANDALIA

Business Name

SHANE BAVANTRAI MANDALIA DO

Original Issue Date

07/01/2018

Effective Date

07/01/2018

Expiration Date

06/30/2019

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

10/02/2019