ANDREW J KAVANAUGH-BLACK Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****98

License Status

NOT RENEWED

Business

First Name

ANDREW

Middle

Last Name

KAVANAUGH-BLACK

Business Name

ANDREW J KAVANAUGH-BLACK

Original Issue Date

03/24/2003

Effective Date

03/24/2003

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60618

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008