DEREK LEWIS TENNENHOUSE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036113449

License Status

NOT RENEWED

Business

First Name

DEREK

Middle

LEWIS

Last Name

TENNENHOUSE

Suffix

Business Name

DEREK LEWIS TENNENHOUSE MD

Original Issue Date

04/14/2005

Effective Date

08/01/2005

Expiration Date

07/31/2008

City

SPARTA

State

Zip

62286

County

RANDOLPH

Ever Disciplined

LastModifiedDate

04/08/2009

Case Number

2005006531

Action

Probation

Discipline Start Date

09/07/2007

Discipline Reason

restored to indefinite probation.