LESLEY M BLAKE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****47

License Status

NOT RENEWED

Business

First Name

LESLEY M

Last Name

BLAKE

Suffix

Business Name

LESLEY M BLAKE MD

Original Issue Date

02/26/1985

Effective Date

02/26/1985

Expiration Date

07/31/1993

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006