MICHAEL J BLAKE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036079976

License Status

NOT RENEWED

Business

First Name

MICHAEL J

Last Name

BLAKE

Suffix

Business Name

MICHAEL J BLAKE MD

Original Issue Date

05/25/1990

Effective Date

05/25/1990

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006