LUKE RICHARD FREDERICK 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

Title

First Name

LUKE

Middle

RICHARD

Last Name

FREDERICK

Business Name

LUKE RICHARD FREDERICK MD

Original Issue Date

06/09/2016

Effective Date

05/20/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/20/2023