MICHAEL P BLOUSTINE MD - Medical Doctor License in Illinois | # 125056742

MICHAEL P BLOUSTINE MD

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056742

License Status

EXPIRED

Business

N

Title

MD

First Name

MICHAEL

Middle

P

Last Name

BLOUSTINE

Business Name

MICHAEL P BLOUSTINE MD

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2013

State

IL

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

N

LastModifiedDate

10/07/2013