RUSSELL J SHAH Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****75

License Status

NOT RENEWED

Business

First Name

RUSSELL J

Last Name

SHAH

Business Name

RUSSELL J SHAH

Original Issue Date

03/16/2000

Effective Date

03/16/2000

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60607

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006