LISA R MACK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034802

License Status

EXPIRED

Business

First Name

LISA

Middle

Last Name

MACK

Business Name

LISA R MACK

Original Issue Date

05/30/1996

Effective Date

05/30/1996

Expiration Date

06/16/1997

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006