FAUZIA RAFAT SHAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

NOT RENEWED

Business

First Name

FAUZIA

Middle

RAFAT

Last Name

SHAH

Suffix

Business Name

FAUZIA RAFAT SHAH MD

Original Issue Date

08/28/2003

Effective Date

08/28/2003

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006