ANDREA R PENEPACKER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****25

License Status

NOT RENEWED

Business

First Name

ANDREA

Middle

Last Name

PENEPACKER

Suffix

Business Name

ANDREA R PENEPACKER MD

Original Issue Date

03/28/2007

Effective Date

03/28/2007

Expiration Date

07/31/2008

City

WAUKEGAN

State

Zip

60085

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008