WAYNE J BLASZAK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125019498

License Status

EXPIRED

Business

First Name

WAYNE J

Last Name

BLASZAK

Suffix

Business Name

WAYNE J BLASZAK MD

Original Issue Date

06/18/1986

Effective Date

06/18/1986

Expiration Date

07/01/1989

City

CHICAGO

State

Zip

60613

County

COOK

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

09/22/2006