CHARLES D BLACKWELL MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

VISITING PHYSICIAN PERMIT

License Number

106000149

License Status

EXPIRED

Business

First Name

CHARLES

Middle

Last Name

BLACKWELL

Suffix

Business Name

CHARLES D BLACKWELL MD

Original Issue Date

03/18/2002

Effective Date

03/18/2002

Expiration Date

09/17/2002

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

09/23/2006