DEREK E CLEVIDENCE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****38

License Status

CANCELLED

Business

First Name

DEREK

Middle

Last Name

CLEVIDENCE

Suffix

Business Name

DEREK E CLEVIDENCE MD

Original Issue Date

07/06/1999

Effective Date

07/06/1999

Expiration Date

07/31/2002

City

PARK RIDGE

State

Zip

60068

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006