MICHAEL THOMAS STACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036158064

License Status

NOT RENEWED

Business

Title

First Name

MICHAEL

Middle

THOMAS

Last Name

STACK

Business Name

MICHAEL THOMAS STACK MD

Original Issue Date

08/19/2021

Effective Date

08/19/2021

Expiration Date

07/31/2023

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

11/30/2023