DONNA J BLAKE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125018584

License Status

EXPIRED

Business

First Name

DONNA

Middle

Last Name

BLAKE

Business Name

DONNA J BLAKE

Original Issue Date

06/13/1985

Effective Date

06/13/1985

Expiration Date

07/01/1988

City

EVANSTON

State

Zip

60202

County

COOK

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

09/22/2006