KEITH B SHANKAR MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125076590

License Status

CANCELLED

Business

Title

First Name

KEITH

Middle

Last Name

SHANKAR

Business Name

KEITH B SHANKAR MD

Original Issue Date

07/01/2020

Effective Date

07/01/2020

Expiration Date

06/30/2023

City

LOVES PARK

State

Zip

61111

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/07/2020