BLAKE BODENDORFER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036152051

License Status

NOT RENEWED

Business

Title

First Name

BLAKE

Last Name

BODENDORFER

Business Name

BLAKE BODENDORFER MD

Original Issue Date

03/04/2020

Effective Date

07/30/2020

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

11/30/2023