AUDRA BLAZIENE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

VISITING PHYSICIAN PERMIT

License Number

106000035

License Status

EXPIRED

Business

First Name

AUDRA

Last Name

BLAZIENE

Business Name

AUDRA BLAZIENE

Original Issue Date

08/26/1996

Effective Date

08/26/1996

Expiration Date

01/15/1997

City

MAYWOOD

State

Zip

60153

County

COOK

Ever Disciplined

LastModifiedDate

09/23/2006