WILLIAM VINCENT BLAZEK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

NOT RENEWED

Business

First Name

WILLIAM VINCENT

Last Name

BLAZEK

Suffix

Business Name

WILLIAM VINCENT BLAZEK MD

Original Issue Date

01/01/1997

Effective Date

07/08/2008

Expiration Date

07/31/2011

City

PARK RIDGE

State

Zip

60068

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011