HENRY R BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036084230

License Status

NOT RENEWED

Business

First Name

HENRY R

Last Name

BLACK

Suffix

Business Name

HENRY R BLACK MD

Original Issue Date

04/09/1992

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

11/06/2008