DOMINIK WIEST Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****52

License Status

INOPERATIVE

Business

First Name

DOMINIK

Last Name

WIEST

Business Name

DOMINIK WIEST

Original Issue Date

07/13/2020

Effective Date

07/13/2020

Expiration Date

03/01/2022

City

MORTON GROVE

State

Zip

60053

County

COOK

Ever Disciplined

LastModifiedDate

01/03/2022