MABLE LOUISE BLACKWELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

NOT RENEWED

Business

First Name

MABLE

Middle

LOUISE

Last Name

BLACKWELL

Suffix

Business Name

MABLE LOUISE BLACKWELL MD

Original Issue Date

11/03/1981

Effective Date

10/17/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60643

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014