CAROL SUSAN BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036065225

License Status

NOT RENEWED

Business

First Name

CAROL SUSAN

Last Name

BLACK

Suffix

Business Name

CAROL SUSAN BLACK MD

Original Issue Date

08/20/1982

Effective Date

08/20/1982

Expiration Date

07/31/2005

City

OAK PARK

State

Zip

60302

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/09/2006