MABLE LOUISE BLACKWELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036059557

License Status

NOT RENEWED

Business

First Name

MABLE

Middle

LOUISE

Last Name

BLACKWELL

Suffix

Business Name

MABLE LOUISE BLACKWELL MD

Original Issue Date

10/15/1979

Effective Date

05/18/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60643

County

COOK

Ever Disciplined

LastModifiedDate

11/17/2014