MICHAEL BLAIVAS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

First Name

MICHAEL

Last Name

BLAIVAS

Suffix

Business Name

MICHAEL BLAIVAS MD

Original Issue Date

03/26/1998

Effective Date

03/26/1998

Expiration Date

07/31/2008

City

OAK LAWN

State

Zip

60456

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008