BLAKE WILLIAM MILLER DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036172118

License Status

ACTIVE

Business

Title

First Name

BLAKE

Middle

WILLIAM

Last Name

MILLER

Business Name

BLAKE WILLIAM MILLER DO

Original Issue Date

09/24/2024

Effective Date

09/24/2024

Expiration Date

07/31/2026

City

GRAND RAPIDS

State

Zip

49503

Ever Disciplined

LastModifiedDate

09/24/2024