MARLENE L BLAISE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

NOT RENEWED

Business

First Name

MARLENE L

Last Name

BLAISE

Suffix

Business Name

MARLENE L BLAISE MD

Original Issue Date

08/08/1995

Effective Date

08/08/1995

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006