DANE JACK CHURCH MD - Medical Doctor License in Illinois | # 036148467

DANE JACK CHURCH MD

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036148467

License Status

ACTIVE

Business

N

Title

MD

First Name

DANE

Middle

JACK

Last Name

CHURCH

Business Name

DANE JACK CHURCH MD

Original Issue Date

03/06/2019

Effective Date

05/02/2023

Expiration Date

07/31/2026

State

IL

Ever Disciplined

N

LastModifiedDate

05/02/2023