IRENE FEDOROVICH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

ACTIVE

Business

First Name

IRENE

Last Name

FEDOROVICH

Suffix

Business Name

IRENE FEDOROVICH MD

Original Issue Date

08/19/2003

Effective Date

05/01/2023

Expiration Date

07/31/2026

City

MARION

State

Zip

62959

County

WILLIAMSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/01/2023