NATHAN SAMUEL SHANE DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****55

License Status

NOT RENEWED

Business

Title

DPM

First Name

NATHAN

Middle

SAMUEL

Last Name

SHANE

Business Name

NATHAN SAMUEL SHANE DPM

Original Issue Date

01/30/2018

Effective Date

01/03/2019

Expiration Date

01/31/2021

City

DES PLAINES

State

Zip

60016

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/11/2021