SHAUKAT A THANAWALLA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

SHAUKAT A

Last Name

THANAWALLA

Suffix

Business Name

SHAUKAT A THANAWALLA MD

Original Issue Date

03/11/1997

Effective Date

03/11/1997

Expiration Date

07/31/1999

City

OFALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006