Indiana
Professional Licensing Agency
Shanna V. Kautzmann
Controlled Substance Registration - Physician
License number
01058244B
Date granted
04/22/2004
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Heart City Health Center, 236 Simpson Avenue, Elkhart IN 46516
indianalicensing.org
ID 5848437
LAST UPDATED 2024-03-18 13:09:43 UTC
LAST UPDATED 2024-03-18 13:09:43 UTC
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