Indiana
Professional Licensing Agency
Kenneth W. Blumenthal
Controlled Substance Registration-Osteopathic Physician
License number
02000639B
Date granted
06/30/1986
Date expires
10/31/2015
Class
Controlled Substance Registration-Osteopathic Physician
Status
Active
Address
Primary Care, P.C., 3125 Willowcreek Road, Portage IN 46368
indianalicensing.org
ID 5811856
LAST UPDATED 2024-04-30 09:30:57 UTC
LAST UPDATED 2024-04-30 09:30:57 UTC
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