KELLY SHAWN DERBIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

SHAWN

Last Name

DERBIN

Suffix

Business Name

KELLY SHAWN DERBIN MD

Original Issue Date

10/24/2000

Effective Date

10/24/2000

Expiration Date

07/31/2005

City

HINSDALE

State

Zip

60521

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006