SUJATA MADHUKAR SHANBHAG MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

CANCELLED

Business

First Name

SUJATA

Middle

MADHUKAR

Last Name

SHANBHAG

Suffix

Business Name

SUJATA MADHUKAR SHANBHAG MD

Original Issue Date

10/18/2005

Effective Date

10/18/2005

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/17/2008