EDWARD D FREDERICKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

First Name

EDWARD D

Last Name

FREDERICKSON

Suffix

Business Name

EDWARD D FREDERICKSON MD

Original Issue Date

03/03/1982

Effective Date

03/03/1982

Expiration Date

07/31/1987

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006