GEROLD J BLAZEK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125015476

License Status

EXPIRED

Business

First Name

GEROLD J

Last Name

BLAZEK

Suffix

Business Name

GEROLD J BLAZEK MD

Original Issue Date

06/15/1983

Effective Date

06/15/1983

Expiration Date

07/01/1985

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

09/22/2006