WAYNE T CORNBLATH - Medical Doctor License in Illinois | # 125015959

WAYNE T CORNBLATH

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125015959

License Status

EXPIRED

Business

N

First Name

WAYNE

Middle

T

Last Name

CORNBLATH

Business Name

WAYNE T CORNBLATH

Original Issue Date

06/15/1983

Effective Date

06/15/1983

Expiration Date

06/27/1985

State

IL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006