TIA JAVANTE DORN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

NOT RENEWED

Business

First Name

TIA

Middle

JAVANTE

Last Name

DORN

Suffix

Business Name

TIA JAVANTE DORN MD

Original Issue Date

06/28/2016

Effective Date

06/28/2016

Expiration Date

07/31/2017

City

FOREST PARK

State

Zip

60130

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020