SAM SHIESHA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****91

License Status

NOT RENEWED

Business

First Name

SAM

Last Name

SHIESHA

Business Name

SAM SHIESHA

Original Issue Date

06/14/1988

Effective Date

06/14/1988

Expiration Date

07/31/1990

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006