ASHLEY GALE BLACK DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****87

License Status

ACTIVE

Business

Title

First Name

ASHLEY

Middle

GALE

Last Name

BLACK

Business Name

ASHLEY GALE BLACK DO

Original Issue Date

08/21/2012

Effective Date

04/19/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/19/2023