BRIAN J BLONIGEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

Title

First Name

BRIAN

Middle

Last Name

BLONIGEN

Business Name

BRIAN J BLONIGEN MD

Original Issue Date

04/30/2013

Effective Date

04/25/2014

Expiration Date

07/31/2017

City

JOLIET

State

Zip

60435

County

WILL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017