BLAKE BODENDORFER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

NOT RENEWED

Business

Title

First Name

BLAKE

Last Name

BODENDORFER

Business Name

BLAKE BODENDORFER MD

Original Issue Date

05/11/2020

Effective Date

05/11/2020

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023