SAMANTHA ERIN BLANK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065333

License Status

EXPIRED

Business

Title

First Name

SAMANTHA

Middle

ERIN

Last Name

BLANK

Business Name

SAMANTHA ERIN BLANK MD

Original Issue Date

07/01/2014

Effective Date

07/01/2014

Expiration Date

06/30/2017

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/19/2017