ELLEN M HENNECKE DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125023389

License Status

EXPIRED

Business

First Name

ELLEN M

Last Name

HENNECKE

Suffix

Business Name

ELLEN M HENNECKE DO

Original Issue Date

04/25/1989

Effective Date

04/25/1989

Expiration Date

06/22/1992

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

09/22/2006