STEPHANIE RACHEL BLACK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****82

License Status

ACTIVE

Business

First Name

STEPHANIE

Middle

RACHEL

Last Name

BLACK

Suffix

Business Name

STEPHANIE RACHEL BLACK MD

Original Issue Date

05/08/1998

Effective Date

05/03/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60613

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/03/2023