GEROLD J BLAZEK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036071341

License Status

NOT RENEWED

Business

First Name

GEROLD J

Last Name

BLAZEK

Suffix

Business Name

GEROLD J BLAZEK MD

Original Issue Date

08/02/1985

Effective Date

08/02/1985

Expiration Date

07/31/1987

City

CHICAGO

State

Zip

60638

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006