DAVID KEITH HENDRICKSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

NOT RENEWED

Business

First Name

DAVID KEITH

Last Name

HENDRICKSEN

Suffix

Business Name

DAVID KEITH HENDRICKSEN MD

Original Issue Date

09/24/1981

Effective Date

06/26/2014

Expiration Date

07/31/2017

City

METAMORA

State

Zip

61548

County

WOODFORD

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020