PRAKASH D SHAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****82

License Status

NOT RENEWED

Business

Title

First Name

PRAKASH

Middle

Last Name

SHAH

Business Name

PRAKASH D SHAH MD

Original Issue Date

02/16/2021

Effective Date

02/16/2021

Expiration Date

07/31/2023

City

KENOSHA

State

Zip

53144

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

IV V

Ever Disciplined

LastModifiedDate

11/30/2023