DOMINADOR FREDRICK P CARIASO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

NOT RENEWED

Business

First Name

DOMINADOR

Middle

FREDRICK P

Last Name

CARIASO

Suffix

Business Name

DOMINADOR FREDRICK P CARIASO MD

Original Issue Date

10/13/2000

Effective Date

10/13/2000

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006