MATTHEW LEE DOMINGUEZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

NOT RENEWED

Business

Title

First Name

MATTHEW

Middle

LEE

Last Name

DOMINGUEZ

Business Name

MATTHEW LEE DOMINGUEZ MD

Original Issue Date

09/08/2015

Effective Date

09/08/2015

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017