MARY SUSAN BLANKS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****83

License Status

NOT RENEWED

Business

Title

First Name

MARY

Middle

SUSAN

Last Name

BLANKS

Business Name

MARY SUSAN BLANKS MD

Original Issue Date

03/19/1982

Effective Date

03/19/1982

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60605

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2017