STACEY ANNE BENNIS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125063353

License Status

CANCELLED

Business

Title

First Name

STACEY

Middle

ANNE

Last Name

BENNIS

Business Name

STACEY ANNE BENNIS MD

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2018

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Sports Medicine (PM&R)

Ever Disciplined

LastModifiedDate

06/08/2017