ERIN BETH DOMINIAK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048055

License Status

EXPIRED

Business

First Name

ERIN

Middle

BETH

Last Name

DOMINIAK

Suffix

Business Name

ERIN BETH DOMINIAK MD

Original Issue Date

06/28/2004

Effective Date

06/28/2004

Expiration Date

06/27/2007

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/03/2007