CHARLES MARTIN SLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

NOT RENEWED

Business

First Name

CHARLES MARTIN

Last Name

SLACK

Suffix

Business Name

CHARLES MARTIN SLACK MD

Original Issue Date

01/01/1997

Effective Date

07/21/2020

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60613

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023