PRAKASH D SHAH 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

Title

First Name

PRAKASH

Middle

Last Name

SHAH

Business Name

PRAKASH D SHAH MD

Original Issue Date

06/27/1997

Effective Date

05/30/2017

Expiration Date

09/30/2020

City

GURNEE

State

Zip

60031

County

LAKE

Controlled Substance Schedule

II IV V

Ever Disciplined

LastModifiedDate

01/14/2021