JACOB WILLIAM GROENENDYK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125073852

License Status

CANCELLED

Business

Title

First Name

JACOB

Middle

WILLIAM

Last Name

GROENENDYK

Business Name

JACOB WILLIAM GROENENDYK MD

Original Issue Date

06/20/2019

Effective Date

06/20/2019

Expiration Date

06/19/2022

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/02/2019