JUSTIN R BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****87

License Status

NOT RENEWED

Business

First Name

JUSTIN

Middle

Last Name

BLACK

Suffix

Business Name

JUSTIN R BLACK MD

Original Issue Date

02/23/2009

Effective Date

02/23/2009

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011