LEE M DEDORE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****22

License Status

ACTIVE

Business

First Name

LEE

Middle

Last Name

DEDORE

Business Name

LEE M DEDORE

Original Issue Date

04/01/2010

Effective Date

12/17/2025

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60612

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/17/2025