SYED M SHAN-UL ISLAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****66

License Status

NOT RENEWED

Business

Title

First Name

SYED M

Middle

SHAN-UL

Last Name

ISLAM

Business Name

SYED M SHAN-UL ISLAM MD

Original Issue Date

12/20/2011

Effective Date

12/20/2011

Expiration Date

07/31/2014

City

VALPARAISO

State

Zip

46383

County

INDIANA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020