ANNIE T BORDERS-BLACKWELL DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

NOT RENEWED

Business

First Name

ANNIE

Middle

Last Name

BORDERS-BLACKWELL

Suffix

Business Name

ANNIE T BORDERS-BLACKWELL DO

Original Issue Date

05/16/2008

Effective Date

07/29/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60617

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2017