ALAN TODD BLANK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

ACTIVE

Business

Title

First Name

ALAN

Middle

TODD

Last Name

BLANK

Business Name

ALAN TODD BLANK MD

Original Issue Date

06/27/2017

Effective Date

04/18/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/18/2023