JUDY KRISTINE BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036113715

License Status

NOT RENEWED

Business

First Name

JUDY

Middle

KRISTINE

Last Name

BLACK

Suffix

Business Name

JUDY KRISTINE BLACK MD

Original Issue Date

05/18/2005

Effective Date

04/29/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017