LISA ANN BLACKWOOD MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061636

License Status

EXPIRED

Business

Title

First Name

LISA

Middle

ANN

Last Name

BLACKWOOD

Business Name

LISA ANN BLACKWOOD MD

Original Issue Date

07/01/2015

Effective Date

07/01/2015

Expiration Date

06/30/2018

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

10/25/2018