TIMOTHY DANIEL BLAKE MD - Medical Doctor License in Illinois | # 125040971

TIMOTHY DANIEL BLAKE MD

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125040971

License Status

EXPIRED

Business

N

First Name

TIMOTHY

Middle

DANIEL

Last Name

BLAKE

Suffix

MD

Business Name

TIMOTHY DANIEL BLAKE MD

Original Issue Date

06/23/2000

Effective Date

06/23/2000

Expiration Date

06/22/2001

State

IL

Ever Disciplined

N

LastModifiedDate

09/22/2006