ANDRE DEDRICK IVY MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058363

License Status

CANCELLED

Business

Title

First Name

ANDRE

Middle

DEDRICK

Last Name

IVY

Business Name

ANDRE DEDRICK IVY MD

Original Issue Date

06/23/2010

Effective Date

06/23/2010

Expiration Date

06/22/2013

City

LOMBARD

State

Zip

60148

County

DUPAGE

Specialty/Qualifier

Orthopaedic Surgery

Ever Disciplined

LastModifiedDate

06/02/2010