JAMES WALTER FREDERIKSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****29

License Status

NOT RENEWED

Business

First Name

JAMES WALTER

Last Name

FREDERIKSEN

Suffix

Business Name

JAMES WALTER FREDERIKSEN MD

Original Issue Date

07/13/1981

Effective Date

06/03/2014

Expiration Date

07/31/2017

City

PARK RIDGE

State

Zip

60068

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020