KEITH MICHAEL LADENDORF Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****92

License Status

ACTIVE

Business

First Name

KEITH

Middle

MICHAEL

Last Name

LADENDORF

Business Name

KEITH MICHAEL LADENDORF

Original Issue Date

10/03/2005

Effective Date

01/15/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60631

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/15/2026