WAYNE S BLAKE DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125029952

License Status

EXPIRED

Business

First Name

WAYNE

Middle

Last Name

BLAKE

Suffix

Business Name

WAYNE S BLAKE DO

Original Issue Date

05/28/1993

Effective Date

05/28/1993

Expiration Date

06/30/1996

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006