JUDY KRISTINE BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

NOT RENEWED

Business

First Name

JUDY

Middle

KRISTINE

Last Name

BLACK

Suffix

Business Name

JUDY KRISTINE BLACK MD

Original Issue Date

07/26/2005

Effective Date

04/29/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017