JEFFREY ALAN KORNBLUM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****68

License Status

NOT RENEWED

Business

First Name

JEFFREY

Middle

ALAN

Last Name

KORNBLUM

Suffix

Business Name

JEFFREY ALAN KORNBLUM MD

Original Issue Date

06/02/2009

Effective Date

06/27/2011

Expiration Date

07/31/2014

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014