DERRICK ANTHONY MACKAVICH DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125041152

License Status

EXPIRED

Business

First Name

DERRICK

Middle

ANTHONY

Last Name

MACKAVICH

Suffix

Business Name

DERRICK ANTHONY MACKAVICH DO

Original Issue Date

07/01/2000

Effective Date

07/01/2000

Expiration Date

06/30/2004

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

09/22/2006