JUSTIN R BLACK MD - Medical Doctor License in Illinois | # 036121182

JUSTIN R BLACK MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036121182

License Status

NOT RENEWED

Business

N

First Name

JUSTIN

Middle

R

Last Name

BLACK

Suffix

MD

Business Name

JUSTIN R BLACK MD

Original Issue Date

06/17/2008

Effective Date

06/17/2008

Expiration Date

07/31/2011

State

IL

Ever Disciplined

N

LastModifiedDate

11/14/2011