MITRA SUSAN SHULTZ Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****74

License Status

ACTIVE

Business

First Name

MITRA

Middle

SUSAN

Last Name

SHULTZ

Business Name

MITRA SUSAN SHULTZ

Original Issue Date

01/02/2018

Effective Date

12/16/2023

Expiration Date

03/01/2026

City

GRANITE CITY

State

Zip

62040

County

MADISON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025