SCOTT RANDALL HENNEMAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125054277

License Status

CANCELLED

Business

Title

First Name

SCOTT

Middle

RANDALL

Last Name

HENNEMAN

Business Name

SCOTT RANDALL HENNEMAN MD

Original Issue Date

06/24/2011

Effective Date

06/24/2011

Expiration Date

06/23/2013

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

04/25/2011