THEODORE L VANDERVELDE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****73

License Status

NOT RENEWED

Business

First Name

THEODORE

Middle

Last Name

VANDERVELDE

Suffix

Business Name

THEODORE L VANDERVELDE MD

Original Issue Date

12/13/2001

Effective Date

08/02/2017

Expiration Date

09/30/2020

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021