KENNETH J BLOOM MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125017598

License Status

EXPIRED

Business

First Name

KENNETH J

Last Name

BLOOM

Suffix

Business Name

KENNETH J BLOOM MD

Original Issue Date

07/25/1984

Effective Date

07/25/1984

Expiration Date

06/25/1986

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pathology

Ever Disciplined

LastModifiedDate

09/22/2006