SHILPA P BAHETHI Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

First Name

SHILPA

Middle

Last Name

BAHETHI

Business Name

SHILPA P BAHETHI

Original Issue Date

06/23/2003

Effective Date

06/23/2003

Expiration Date

07/31/2005

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006