SHANA GITTLE KUSIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036124701

License Status

NOT RENEWED

Business

Title

First Name

SHANA

Middle

GITTLE

Last Name

KUSIN

Business Name

SHANA GITTLE KUSIN MD

Original Issue Date

12/04/2009

Effective Date

12/04/2009

Expiration Date

07/31/2011

City

PORTLAND

State

Zip

97232

Ever Disciplined

LastModifiedDate

11/14/2011