TIMOTHY DANIEL BLAKE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125040971

License Status

EXPIRED

Business

First Name

TIMOTHY

Middle

DANIEL

Last Name

BLAKE

Suffix

Business Name

TIMOTHY DANIEL BLAKE MD

Original Issue Date

06/23/2000

Effective Date

06/23/2000

Expiration Date

06/22/2001

City

CHICAGO

State

Zip

60631

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006