WAYNE T CORNBLATH Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125015959

License Status

EXPIRED

Business

First Name

WAYNE

Middle

Last Name

CORNBLATH

Business Name

WAYNE T CORNBLATH

Original Issue Date

06/15/1983

Effective Date

06/15/1983

Expiration Date

06/27/1985

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006