JACOB RALPH HENINGER DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****93

License Status

NOT RENEWED

Business

Title

First Name

JACOB

Middle

RALPH

Last Name

HENINGER

Business Name

JACOB RALPH HENINGER DO

Original Issue Date

10/03/2016

Effective Date

05/11/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021