CONSTANCE D SHABAZZ Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

CANCELLED

Business

First Name

CONSTANCE D

Last Name

SHABAZZ

Business Name

CONSTANCE D SHABAZZ

Original Issue Date

09/28/1988

Effective Date

09/28/1988

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60643

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006