MICHAEL SHANE HENNESY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

ACTIVE

Business

Title

First Name

MICHAEL

Middle

SHANE

Last Name

HENNESY

Business Name

MICHAEL SHANE HENNESY MD

Original Issue Date

08/14/2012

Effective Date

05/20/2023

Expiration Date

07/31/2026

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/20/2023