BLAKE THOMAS MOSKAL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125078826

License Status

CANCELLED

Business

Title

First Name

BLAKE

Middle

THOMAS

Last Name

MOSKAL

Prefix

Business Name

BLAKE THOMAS MOSKAL MD

Original Issue Date

06/25/2021

Effective Date

06/25/2021

Expiration Date

06/24/2024

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/03/2021