MARC DOUGLAS SHIELDS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

NOT RENEWED

Business

First Name

MARC

Middle

DOUGLAS

Last Name

SHIELDS

Suffix

Business Name

MARC DOUGLAS SHIELDS MD

Original Issue Date

01/23/2002

Effective Date

01/23/2002

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006