VITALIY YURYEVICH DOMASHEVICH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****48

License Status

NOT RENEWED

Business

First Name

VITALIY

Middle

YURYEVICH

Last Name

DOMASHEVICH

Suffix

Business Name

VITALIY YURYEVICH DOMASHEVICH MD

Original Issue Date

05/21/2001

Effective Date

05/21/2001

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011