ANDRE DEDRICK IVY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

ACTIVE

Business

Title

First Name

ANDRE

Middle

DEDRICK

Last Name

IVY

Business Name

ANDRE DEDRICK IVY MD

Original Issue Date

05/22/2013

Effective Date

07/07/2023

Expiration Date

07/31/2026

City

LOMBARD

State

Zip

60148

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/07/2023