MADISON DOMIN Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****32

License Status

ACTIVE

Business

First Name

MADISON

Last Name

DOMIN

Business Name

MADISON DOMIN

Original Issue Date

10/29/2024

Effective Date

01/27/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60617

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/27/2026