SHANE PATRICK SMITH MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001335

License Status

EXPIRED

Business

Title

First Name

SHANE

Middle

PATRICK

Last Name

SMITH

Business Name

SHANE PATRICK SMITH MD

Original Issue Date

04/18/2020

Effective Date

04/18/2020

Expiration Date

07/17/2020

City

CHICAGO

State

Zip

60637

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

11/19/2020