SHANTAY DANIELLE THOMAS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067342

License Status

CANCELLED

Business

Title

First Name

SHANTAY

Middle

DANIELLE

Last Name

THOMAS

Business Name

SHANTAY DANIELLE THOMAS MD

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2018

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/06/2017