CRYSTAL TENNILLE CLARK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036131343

License Status

ACTIVE

Business

Title

First Name

CRYSTAL

Middle

TENNILLE

Last Name

CLARK

Business Name

CRYSTAL TENNILLE CLARK MD

Original Issue Date

09/10/2012

Effective Date

07/16/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60653

County

COOK

Ever Disciplined

LastModifiedDate

07/16/2023