JOHN BERTHOLD NANNINGA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

CANCELLED

Business

First Name

JOHN BERTHOLD

Last Name

NANNINGA

Suffix

Business Name

JOHN BERTHOLD NANNINGA MD

Original Issue Date

01/01/1997

Effective Date

05/05/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014