RENATA M BLOCK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****16

License Status

ACTIVE

Business

First Name

RENATA

Middle

Last Name

BLOCK

Business Name

RENATA M BLOCK

Original Issue Date

04/18/2003

Effective Date

12/03/2025

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60654

County

COOK

Ever Disciplined

LastModifiedDate

12/03/2025