SUSAN M SHAW Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****85

License Status

NOT RENEWED

Business

First Name

SUSAN

Middle

Last Name

SHAW

Business Name

SUSAN M SHAW

Original Issue Date

08/12/1998

Effective Date

06/09/2014

Expiration Date

07/31/2017

City

LAKE FOREST

State

Zip

60045

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017