SHANE DAVID BUSH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

NOT RENEWED

Business

Title

First Name

SHANE

Middle

DAVID

Last Name

BUSH

Business Name

SHANE DAVID BUSH MD

Original Issue Date

07/09/2012

Effective Date

07/09/2012

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014