NICHOLAS RAY BLICKENSTAFF MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036150002

License Status

NOT RENEWED

Business

Title

First Name

NICHOLAS

Middle

RAY

Last Name

BLICKENSTAFF

Business Name

NICHOLAS RAY BLICKENSTAFF MD

Original Issue Date

06/27/2019

Effective Date

05/14/2020

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60602

County

COOK

Ever Disciplined

LastModifiedDate

11/30/2023