SUPARNA T SHIVASHANKARA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

NOT RENEWED

Business

Title

First Name

SUPARNA

Middle

Last Name

SHIVASHANKARA

Business Name

SUPARNA T SHIVASHANKARA MD

Original Issue Date

12/05/2016

Effective Date

12/05/2016

Expiration Date

07/31/2017

City

PEORIA

State

Zip

61636

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017