CHARLES ROBERT BLACKWELL DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074845

License Status

EXPIRED

Business

Title

First Name

CHARLES

Middle

ROBERT

Last Name

BLACKWELL

Business Name

CHARLES ROBERT BLACKWELL DO

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2022

City

CHICAGO

State

Zip

60625

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

10/11/2022