STEPHEN T PENEPACKER Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****01

License Status

CANCELLED

Business

First Name

STEPHEN

Middle

Last Name

PENEPACKER

Business Name

STEPHEN T PENEPACKER

Original Issue Date

08/28/2002

Effective Date

08/28/2002

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020