SHANE CLARK DO - Medical Doctor License in Illinois | # 130001359

SHANE CLARK DO

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001359

License Status

EXPIRED

Business

N

Title

DO

First Name

SHANE

Last Name

CLARK

Business Name

SHANE CLARK DO

Original Issue Date

05/25/2020

Effective Date

05/25/2020

Expiration Date

06/24/2020

State

IL

Specialty/Qualifier

Geriatric Medicine

Ever Disciplined

N

LastModifiedDate

11/19/2020