MOLLY DIANNE BLACK MD - Medical Doctor License in Illinois | # 036123359

MOLLY DIANNE BLACK MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036123359

License Status

NOT RENEWED

Business

N

Title

MD

First Name

MOLLY

Middle

DIANNE

Last Name

BLACK

Business Name

MOLLY DIANNE BLACK MD

Original Issue Date

05/05/2009

Effective Date

05/05/2009

Expiration Date

07/31/2011

State

IL

Ever Disciplined

N

LastModifiedDate

11/14/2011