DIVYA SARATH SHAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

NOT RENEWED

Business

Title

First Name

DIVYA

Middle

SARATH

Last Name

SHAH

Business Name

DIVYA SARATH SHAH MD

Original Issue Date

07/07/2017

Effective Date

07/07/2017

Expiration Date

09/30/2020

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021