SHAUN T ITTIARA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

CANCELLED

Business

First Name

SHAUN

Middle

Last Name

ITTIARA

Suffix

Business Name

SHAUN T ITTIARA MD

Original Issue Date

05/22/2013

Effective Date

05/22/2013

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020