DOMINIC EDWARD FULLENKAMP MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

ACTIVE

Business

Title

First Name

DOMINIC

Middle

EDWARD

Last Name

FULLENKAMP

Business Name

DOMINIC EDWARD FULLENKAMP MD

Original Issue Date

03/12/2021

Effective Date

04/25/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/25/2023