MICHAEL O BLACKSTONE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036050000

License Status

NOT RENEWED

Business

First Name

MICHAEL O

Last Name

BLACKSTONE

Suffix

Business Name

MICHAEL O BLACKSTONE MD

Original Issue Date

10/10/1974

Effective Date

04/29/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60618

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017