RAJ L SHIVAJI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

NOT RENEWED

Business

Title

First Name

RAJ

Middle

Last Name

SHIVAJI

Business Name

RAJ L SHIVAJI MD

Original Issue Date

02/02/2012

Effective Date

02/02/2012

Expiration Date

07/31/2014

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/17/2014