TARA AMANDA SHAW MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

First Name

TARA

Middle

AMANDA

Last Name

SHAW

Suffix

Business Name

TARA AMANDA SHAW MD

Original Issue Date

04/21/2005

Effective Date

04/21/2005

Expiration Date

07/31/2008

City

BERWYN

State

Zip

60402

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008