AMY J DERICK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044706

License Status

CANCELLED

Business

First Name

AMY

Middle

Last Name

DERICK

Suffix

Business Name

AMY J DERICK MD

Original Issue Date

06/18/2002

Effective Date

06/18/2002

Expiration Date

06/30/2005

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

09/22/2006