STEPHEN CHARLES BLOOM DO - Medical Doctor License in Illinois | # 125026121

STEPHEN CHARLES BLOOM DO

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125026121

License Status

EXPIRED

Business

N

Title

DO

First Name

STEPHEN

Middle

CHARLES

Last Name

BLOOM

Business Name

STEPHEN CHARLES BLOOM DO

Original Issue Date

04/10/1991

Effective Date

04/10/1991

Expiration Date

06/30/1994

State

IL

Ever Disciplined

N

LastModifiedDate

09/22/2006