MICHAEL J BLAKE MD - Medical Doctor License in Illinois | # 036079976

MICHAEL J BLAKE MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036079976

License Status

NOT RENEWED

Business

N

First Name

MICHAEL J

Last Name

BLAKE

Suffix

MD

Business Name

MICHAEL J BLAKE MD

Original Issue Date

05/25/1990

Effective Date

05/25/1990

Expiration Date

07/31/1999

State

IL

Ever Disciplined

N

LastModifiedDate

09/20/2006