BENJAMIN G DOMB MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****67

License Status

ACTIVE

Business

First Name

BENJAMIN

Middle

Last Name

DOMB

Suffix

Business Name

BENJAMIN G DOMB MD

Original Issue Date

12/08/2021

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

DES PLAINES

State

Zip

60018

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2023