MORGAN C BLAKE DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077532

License Status

CANCELLED

Business

Title

First Name

MORGAN

Middle

Last Name

BLAKE

Business Name

MORGAN C BLAKE DO

Original Issue Date

06/24/2021

Effective Date

06/24/2021

Expiration Date

06/23/2024

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/02/2021