DIANA PURTNOY BLUM Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047364

License Status

EXPIRED

Business

First Name

DIANA

Middle

PURTNOY

Last Name

BLUM

Business Name

DIANA PURTNOY BLUM

Original Issue Date

06/23/2004

Effective Date

06/23/2004

Expiration Date

06/22/2005

City

CHICAGO

State

Zip

60631

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006