DOMINIQUE MAYA STEVENS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****66

License Status

ACTIVE

Business

Title

First Name

DOMINIQUE

Middle

MAYA

Last Name

STEVENS

Business Name

DOMINIQUE MAYA STEVENS MD

Original Issue Date

08/14/2020

Effective Date

07/19/2023

Expiration Date

07/31/2026

City

EVANSTON

State

Zip

60208

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/19/2023