SCOTT RANDALL HENNEMAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036129002

License Status

NOT RENEWED

Business

Title

First Name

SCOTT

Middle

RANDALL

Last Name

HENNEMAN

Business Name

SCOTT RANDALL HENNEMAN MD

Original Issue Date

09/22/2011

Effective Date

09/22/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

11/17/2014