DEEPAK SHIVARAM Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

CANCELLED

Business

First Name

DEEPAK

Last Name

SHIVARAM

Business Name

DEEPAK SHIVARAM

Original Issue Date

04/09/1997

Effective Date

04/09/1997

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006