STEPHEN CHARLES BLOOM DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125026121

License Status

EXPIRED

Business

Title

First Name

STEPHEN

Middle

CHARLES

Last Name

BLOOM

Business Name

STEPHEN CHARLES BLOOM DO

Original Issue Date

04/10/1991

Effective Date

04/10/1991

Expiration Date

06/30/1994

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006