KATHLEEN M DOMINGUEZ MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

ACTIVE

Business

Title

First Name

KATHLEEN

Middle

Last Name

DOMINGUEZ

Business Name

KATHLEEN M DOMINGUEZ MD

Original Issue Date

05/23/2018

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/06/2023