PRAKASH D SHAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036094049

License Status

NOT RENEWED

Business

Title

First Name

PRAKASH

Middle

Last Name

SHAH

Business Name

PRAKASH D SHAH MD

Original Issue Date

08/19/1996

Effective Date

05/18/2020

Expiration Date

07/31/2023

City

KENOSHA

State

Zip

53144

County

WISCONSIN

Ever Disciplined

LastModifiedDate

11/30/2023