MELODY J DERRICK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045863

License Status

CANCELLED

Business

First Name

MELODY

Middle

Last Name

DERRICK

Suffix

Business Name

MELODY J DERRICK MD

Original Issue Date

07/01/2003

Effective Date

07/01/2003

Expiration Date

06/30/2006

City

LA GRANGE

State

Zip

60525

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006