EDWARD B LACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036043409

License Status

NOT RENEWED

Business

First Name

EDWARD

Middle

Last Name

LACK

Suffix

Business Name

EDWARD B LACK MD

Original Issue Date

06/30/1970

Effective Date

06/18/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60610

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017