MICHAEL ANTHONY BLACK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****89

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

ANTHONY

Last Name

BLACK

Business Name

MICHAEL ANTHONY BLACK

Original Issue Date

03/07/2001

Effective Date

03/07/2001

Expiration Date

03/01/2004

City

HINSDALE

State

Zip

60521

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/09/2006