BLAINE M LISNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

NOT RENEWED

Business

First Name

BLAINE M

Last Name

LISNER

Suffix

Business Name

BLAINE M LISNER MD

Original Issue Date

09/18/1986

Effective Date

09/18/1986

Expiration Date

07/31/1987

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020