KATHERINE MARIE BLAKE DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061735

License Status

CANCELLED

Business

Title

First Name

KATHERINE

Middle

MARIE

Last Name

BLAKE

Business Name

KATHERINE MARIE BLAKE DO

Original Issue Date

06/25/2012

Effective Date

06/25/2012

Expiration Date

06/24/2015

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

03/24/2014