JACOB MAXWELL PHILLIP BLOOM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****98

License Status

NOT RENEWED

Business

Title

First Name

JACOB

Middle

MAXWELL PHILLIP

Last Name

BLOOM

Business Name

JACOB MAXWELL PHILLIP BLOOM MD

Original Issue Date

02/07/2014

Effective Date

05/24/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/14/2021