JACOB ISRAEL SHAW MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

NOT RENEWED

Business

Title

First Name

JACOB

Middle

ISRAEL

Last Name

SHAW

Business Name

JACOB ISRAEL SHAW MD

Original Issue Date

12/01/2017

Effective Date

12/01/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60608

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021