License holder summary

Kenneth A. Black is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Kenneth A. Black is 3630 Willowcreek Road, Portage IN 46368. This licensed professional license is current. The license was granted 07/31/1986 and expired on 10/31/2015.

Indiana

Professional Licensing Agency

Kenneth A. Black
Controlled Substance Registration - Physician
License number
01024841B
Date granted
07/31/1986
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
3630 Willowcreek Road, Portage IN 46368
indianalicensing.org
ID 5911113
LAST UPDATED 2024-04-19 06:23:19 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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