NICHOLAS RAY BLICKENSTAFF MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068208

License Status

CANCELLED

Business

Title

First Name

NICHOLAS

Middle

RAY

Last Name

BLICKENSTAFF

Business Name

NICHOLAS RAY BLICKENSTAFF MD

Original Issue Date

07/01/2016

Effective Date

07/01/2016

Expiration Date

06/30/2019

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

05/09/2016