MITRA SUSAN SHULTZ Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006383

License Status

ACTIVE

Business

First Name

MITRA

Middle

SUSAN

Last Name

SHULTZ

Business Name

MITRA SUSAN SHULTZ

Original Issue Date

10/04/2017

Effective Date

12/16/2023

Expiration Date

03/01/2026

City

GLEN CARBON

State

Zip

62034

County

MADISON

Ever Disciplined

LastModifiedDate

12/03/2025