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Licensee Details <br />North Carolina Medical Board <br />Information as of May 8, 2009 <br />Kelly Bossenbroek Fedoriw, MD <br />Public File: NO <br />Current License Status: Active <br />License Number: 2008-01856 <br />Issue Date: 10/28/2008 <br />Limitations <br />Address <br />305 Chatham Dr <br />Chapel Hill, NC 27516 <br />Practice Phone: <br />Individual Information <br />Year of Birth: 1976 Annual Renewal Date: 01/04/2010 <br />Primary Specialty: Family Medicine Board Certified: Yes ABMS or AOA Approved: Yes <br />Secondary Specialty: <br />Area(s) of Practice: Family Practice <br />Hospital Privileges: <br />Out Of State Licenses: Connecticut <br />Out Of Country Licenses: <br />The above State and Country Licenses may be currently Active or Inactive <br />School Name Tvoe Grad Year <br />Medical University of Toledo Ohio Medical School 2003 <br />Hide L~censure History ,_ y, <br />Reason Code License <br />Number <br />2008-01856 <br />Active License <br />Subcategory Issue Date <br />10/28/2008 <br />Expire Date <br />Page 1 of 1 <br />http://www.ncmedboard.org/Clients/NCB OM/Public/Licensee_Details. aspx?&EntityID=316253 8&PublicF... 5/8/20 <br />