MARLENE L BLAISE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125028679

License Status

EXPIRED

Business

First Name

MARLENE L

Last Name

BLAISE

Suffix

Business Name

MARLENE L BLAISE MD

Original Issue Date

06/10/1992

Effective Date

06/10/1992

Expiration Date

06/23/1995

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006