MICHAEL P BLOUSTINE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056742

License Status

EXPIRED

Business

Title

First Name

MICHAEL

Middle

Last Name

BLOUSTINE

Business Name

MICHAEL P BLOUSTINE MD

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2013

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

LastModifiedDate

10/07/2013