KATHLEEN ACKMAN BLAKE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036064711

License Status

NOT RENEWED

Business

First Name

KATHLEEN

Middle

ACKMAN

Last Name

BLAKE

Suffix

Business Name

KATHLEEN ACKMAN BLAKE MD

Original Issue Date

07/13/1982

Effective Date

06/05/2017

Expiration Date

09/30/2020

City

HINSDALE

State

Zip

60521

County

DUPAGE

Ever Disciplined

LastModifiedDate

01/14/2021