MATTHEW LOUIS BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093805

License Status

NOT RENEWED

Business

First Name

MATTHEW LOUIS

Last Name

BLACK

Suffix

Business Name

MATTHEW LOUIS BLACK MD

Original Issue Date

07/27/1996

Effective Date

07/27/1996

Expiration Date

07/31/2005

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

10/09/2006