SCOTT RANDALL HENNEMAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****65

License Status

NOT RENEWED

Business

Title

First Name

SCOTT

Middle

RANDALL

Last Name

HENNEMAN

Business Name

SCOTT RANDALL HENNEMAN MD

Original Issue Date

09/22/2011

Effective Date

09/22/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014