ANN E DOMINGUEZ Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

First Name

ANN

Middle

Last Name

DOMINGUEZ

Business Name

ANN E DOMINGUEZ

Original Issue Date

06/09/2000

Effective Date

06/09/2000

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60623

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006