MICHAEL N FENNER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125020595

License Status

EXPIRED

Business

Title

First Name

MICHAEL

Middle

Last Name

FENNER

Business Name

MICHAEL N FENNER MD

Original Issue Date

05/02/1987

Effective Date

05/02/1987

Expiration Date

07/01/1990

City

SPRINGFIELD

State

Zip

62708

County

SANGAMON

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

09/22/2006