EKTA BAXI SHAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****32

License Status

NOT RENEWED

Business

First Name

EKTA

Middle

BAXI

Last Name

SHAH

Suffix

Business Name

EKTA BAXI SHAH MD

Original Issue Date

04/23/2009

Effective Date

04/23/2009

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011