ANDREW JOHN SHADRACH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

ACTIVE

Business

Title

First Name

ANDREW

Middle

JOHN

Last Name

SHADRACH

Business Name

ANDREW JOHN SHADRACH MD

Original Issue Date

10/28/2022

Effective Date

06/09/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61615

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/09/2023