DERRICK ANTHONY MACKAVICH DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

ACTIVE

Business

First Name

DERRICK

Middle

ANTHONY

Last Name

MACKAVICH

Suffix

Business Name

DERRICK ANTHONY MACKAVICH DO

Original Issue Date

10/21/2003

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2023