ELLEN M HENNECKE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

ACTIVE

Business

First Name

ELLEN M

Last Name

HENNECKE

Suffix

Business Name

ELLEN M HENNECKE DO

Original Issue Date

01/14/1992

Effective Date

06/06/2023

Expiration Date

07/31/2026

City

MOKENA

State

Zip

60448

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/06/2023