MICHAEL JOSE BLANCO MD - Medical Doctor License in Illinois | # 125065291

MICHAEL JOSE BLANCO MD

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065291

License Status

CANCELLED

Business

N

Title

MD

First Name

MICHAEL

Middle

JOSE

Last Name

BLANCO

Business Name

MICHAEL JOSE BLANCO MD

Original Issue Date

06/23/2014

Effective Date

06/23/2014

Expiration Date

06/22/2017

State

IL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

N

LastModifiedDate

05/07/2014