JACOB RALPH HENINGER DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065081

License Status

CANCELLED

Business

Title

First Name

JACOB

Middle

RALPH

Last Name

HENINGER

Business Name

JACOB RALPH HENINGER DO

Original Issue Date

07/01/2014

Effective Date

07/01/2014

Expiration Date

06/30/2017

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

06/06/2014