GEROLD J BLAZEK MD - Medical Doctor License in Illinois | # 125015476

GEROLD J BLAZEK MD

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125015476

License Status

EXPIRED

Business

N

First Name

GEROLD J

Last Name

BLAZEK

Suffix

MD

Business Name

GEROLD J BLAZEK MD

Original Issue Date

06/15/1983

Effective Date

06/15/1983

Expiration Date

07/01/1985

State

IL

Specialty/Qualifier

Anesthesiology

Ever Disciplined

N

LastModifiedDate

09/22/2006