MICHAEL BRENT CLARK - Medical Doctor License in Illinois | # 125051095

MICHAEL BRENT CLARK

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051095

License Status

CANCELLED

Business

N

First Name

MICHAEL

Middle

BRENT

Last Name

CLARK

Business Name

MICHAEL BRENT CLARK

Original Issue Date

06/19/2006

Effective Date

06/19/2006

Expiration Date

06/18/2009

State

IL

Specialty/Qualifier

Psychiatry

Ever Disciplined

N

LastModifiedDate

09/22/2006