JUSTIN R BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036121182

License Status

NOT RENEWED

Business

First Name

JUSTIN

Middle

Last Name

BLACK

Suffix

Business Name

JUSTIN R BLACK MD

Original Issue Date

06/17/2008

Effective Date

06/17/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

11/14/2011