ANDREA R PENEPACKER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

NOT RENEWED

Business

First Name

ANDREA

Middle

Last Name

PENEPACKER

Suffix

Business Name

ANDREA R PENEPACKER MD

Original Issue Date

08/30/2001

Effective Date

08/30/2001

Expiration Date

07/31/2005

City

LINCOLNSHIRE

State

Zip

60069

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006