NATHAN SAMUEL SHANE DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRIC PHYSICIAN

License Number

016005776

License Status

NOT RENEWED

Business

Title

DPM

First Name

NATHAN

Middle

SAMUEL

Last Name

SHANE

Business Name

NATHAN SAMUEL SHANE DPM

Original Issue Date

12/11/2017

Effective Date

01/03/2019

Expiration Date

01/31/2021

City

DES PLAINES

State

Zip

60016

County

COOK

Ever Disciplined

LastModifiedDate

03/11/2021