SHANTHARAJ SAMUEL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

NOT RENEWED

Business

First Name

SHANTHARAJ

Last Name

SAMUEL

Suffix

Business Name

SHANTHARAJ SAMUEL MD

Original Issue Date

01/01/1997

Effective Date

07/11/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60634

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021