MINDY STEVENS SHAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****65

License Status

NOT RENEWED

Business

Title

First Name

MINDY

Middle

STEVENS

Last Name

SHAH

Business Name

MINDY STEVENS SHAH MD

Original Issue Date

09/18/2018

Effective Date

09/18/2018

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021