ADAM J BLACK - Medical Doctor License in Illinois | # 125032587

ADAM J BLACK

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125032587

License Status

EXPIRED

Business

N

First Name

ADAM

Middle

J

Last Name

BLACK

Business Name

ADAM J BLACK

Original Issue Date

05/19/1995

Effective Date

05/19/1995

Expiration Date

06/30/1998

State

IL

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006