BRIAN S SHAH DDS, MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

SHAH

Suffix

DDS, MD

Business Name

BRIAN S SHAH DDS, MD

Original Issue Date

07/22/2013

Effective Date

04/11/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021