DOMINIC EDWARD FULLENKAMP MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125064487

License Status

CANCELLED

Business

Title

First Name

DOMINIC

Middle

EDWARD

Last Name

FULLENKAMP

Business Name

DOMINIC EDWARD FULLENKAMP MD

Original Issue Date

06/23/2014

Effective Date

06/23/2014

Expiration Date

06/22/2017

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/01/2014