AGNES BLAU Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125015377

License Status

EXPIRED

Business

First Name

AGNES

Last Name

BLAU

Business Name

AGNES BLAU

Original Issue Date

06/15/1983

Effective Date

06/15/1983

Expiration Date

07/01/1985

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006