SHRUTI MANISH DAVE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****65

License Status

ACTIVE

Business

Title

First Name

SHRUTI

Middle

MANISH

Last Name

DAVE

Business Name

SHRUTI MANISH DAVE MD

Original Issue Date

10/01/2008

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2023