PATRICE R FREDERICK Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

ACTIVE

Business

First Name

PATRICE

Middle

Last Name

FREDERICK

Business Name

PATRICE R FREDERICK

Original Issue Date

10/04/2010

Effective Date

08/03/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/03/2023