SUSANNE JANE BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036041450

License Status

NOT RENEWED

Business

First Name

SUSANNE JANE

Last Name

BLACK

Suffix

Business Name

SUSANNE JANE BLACK MD

Original Issue Date

11/17/1967

Effective Date

11/17/1967

Expiration Date

07/31/1996

City

GLENVIEW

State

Zip

60025

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006