SHANNON KATHLEEN HEXTRUM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065644

License Status

CANCELLED

Business

Title

First Name

SHANNON

Middle

KATHLEEN

Last Name

HEXTRUM

Business Name

SHANNON KATHLEEN HEXTRUM MD

Original Issue Date

06/22/2017

Effective Date

06/22/2017

Expiration Date

06/21/2018

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

04/04/2017