LAURA ELIZABETH BLACK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062536

License Status

EXPIRED

Business

Title

First Name

LAURA

Middle

ELIZABETH

Last Name

BLACK

Business Name

LAURA ELIZABETH BLACK MD

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2019

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatric Rehabilitation

Ever Disciplined

LastModifiedDate

10/02/2019