CHANAE DEMALLE DIXON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

ACTIVE

Business

Title

First Name

CHANAE

Middle

DEMALLE

Last Name

DIXON

Business Name

CHANAE DEMALLE DIXON MD

Original Issue Date

06/11/2019

Effective Date

05/04/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/04/2023