PRATISH AJAY SHAH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****49

License Status

ACTIVE

Business

Title

First Name

PRATISH

Middle

AJAY

Last Name

SHAH

Business Name

PRATISH AJAY SHAH MD

Original Issue Date

03/31/2015

Effective Date

07/28/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/28/2023