SUSAN FREDRIKSEN MD

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****87

NOT RENEWED

N

MD

SUSAN

FREDRIKSEN

SUSAN FREDRIKSEN MD

10/27/1983

10/27/1983

07/31/2008

CHICAGO

IL

60608

COOK

II III IV V

N

04/07/2011