ANNESSA RENEE BLACKMUN DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****01

License Status

NOT RENEWED

Business

First Name

ANNESSA

Middle

RENEE

Last Name

BLACKMUN

Suffix

DPM

Business Name

ANNESSA RENEE BLACKMUN DPM

Original Issue Date

12/30/2010

Effective Date

02/01/2017

Expiration Date

01/31/2019

City

NORTHBROOK

State

Zip

60062

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

03/28/2019