JACOB MAXWELL PHILLIP BLOOM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

ACTIVE

Business

Title

First Name

JACOB

Middle

MAXWELL PHILLIP

Last Name

BLOOM

Business Name

JACOB MAXWELL PHILLIP BLOOM MD

Original Issue Date

10/28/2016

Effective Date

07/09/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/09/2023