DIPAKKUMAR SHANU SHAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****61

License Status

NOT RENEWED

Business

First Name

DIPAKKUMAR SHANU

Last Name

SHAH

Suffix

Business Name

DIPAKKUMAR SHANU SHAH MD

Original Issue Date

08/26/1987

Effective Date

08/02/2017

Expiration Date

09/30/2020

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021