ALAIN LESAGE FONDJO DOMKAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

NOT RENEWED

Business

First Name

ALAIN LESAGE

Middle

FONDJO

Last Name

DOMKAM

Suffix

Business Name

ALAIN LESAGE FONDJO DOMKAM MD

Original Issue Date

07/13/2005

Effective Date

07/13/2005

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008