ALEXANDER BLANK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****76

License Status

ACTIVE

Business

First Name

ALEXANDER

Last Name

BLANK

Business Name

ALEXANDER BLANK

Original Issue Date

02/03/2021

Effective Date

01/25/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60625

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/25/2026