DOMINIK WIEST Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007755

License Status

NOT RENEWED

Business

First Name

DOMINIK

Last Name

WIEST

Business Name

DOMINIK WIEST

Original Issue Date

06/15/2020

Effective Date

06/15/2020

Expiration Date

03/01/2022

City

MORTON GROVE

State

Zip

60053

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2022