DERRICK ANTHONY MACKAVICH DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036110111

License Status

ACTIVE

Business

First Name

DERRICK

Middle

ANTHONY

Last Name

MACKAVICH

Suffix

Business Name

DERRICK ANTHONY MACKAVICH DO

Original Issue Date

09/15/2003

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

RIVER FOREST

State

Zip

60305

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2023