TINA FRUSCIONE BLACHUT DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125054387

License Status

EXPIRED

Business

Title

First Name

TINA

Middle

FRUSCIONE

Last Name

BLACHUT

Business Name

TINA FRUSCIONE BLACHUT DO

Original Issue Date

06/16/2008

Effective Date

06/16/2008

Expiration Date

06/15/2011

City

BERWYN

State

Zip

60402

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/19/2011