MICHAEL LEE CLARK DO - Medical Doctor License in Illinois | # 125058529

MICHAEL LEE CLARK DO

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058529

License Status

CANCELLED

Business

N

Title

DO

First Name

MICHAEL

Middle

LEE

Last Name

CLARK

Business Name

MICHAEL LEE CLARK DO

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

State

IL

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

N

LastModifiedDate

05/11/2010