ADAM J BLACK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125032587

License Status

EXPIRED

Business

First Name

ADAM

Middle

Last Name

BLACK

Business Name

ADAM J BLACK

Original Issue Date

05/19/1995

Effective Date

05/19/1995

Expiration Date

06/30/1998

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006