TIA JAVANTE DORN MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036141061

License Status

INACTIVE

Business

First Name

TIA

Middle

JAVANTE

Last Name

DORN

Suffix

Business Name

TIA JAVANTE DORN MD

Original Issue Date

06/28/2016

Effective Date

08/02/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60643

County

COOK

Ever Disciplined

LastModifiedDate

04/05/2020