MICHAEL ANTHONY BLACK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001426

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

ANTHONY

Last Name

BLACK

Business Name

MICHAEL ANTHONY BLACK

Original Issue Date

09/18/2000

Effective Date

09/18/2000

Expiration Date

03/01/2004

City

CHICAGO

State

Zip

60647

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006