BASSAM NICHOLAS SHAMMA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

NOT RENEWED

Business

First Name

BASSAM

Middle

NICHOLAS

Last Name

SHAMMA

Suffix

Business Name

BASSAM NICHOLAS SHAMMA MD

Original Issue Date

06/26/2002

Effective Date

06/26/2002

Expiration Date

07/31/2005

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006