NICOLE ELIZABETH BLUM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125078748

License Status

CANCELLED

Business

Title

First Name

NICOLE

Middle

ELIZABETH

Last Name

BLUM

Business Name

NICOLE ELIZABETH BLUM MD

Original Issue Date

06/24/2021

Effective Date

06/24/2021

Expiration Date

06/23/2024

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

04/06/2021