DERIC M PARK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

ACTIVE

Business

Title

First Name

DERIC

Middle

Last Name

PARK

Business Name

DERIC M PARK MD

Original Issue Date

08/09/2018

Effective Date

05/26/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60637

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/26/2023