KEENAN C WANAMAKER DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****20

License Status

NOT RENEWED

Business

Title

First Name

KEENAN

Middle

Last Name

WANAMAKER

Business Name

KEENAN C WANAMAKER DO

Original Issue Date

06/17/2016

Effective Date

06/21/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60610

County

MICHIGAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021