BROOK ERNESTINE MEDICI Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****13

License Status

ACTIVE

Business

First Name

BROOK

Middle

ERNESTINE

Last Name

MEDICI

Business Name

BROOK ERNESTINE MEDICI

Original Issue Date

02/24/2015

Effective Date

12/09/2023

Expiration Date

03/01/2026

City

EVERGREEN PARK

State

Zip

60805

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025