MICHAEL BRENT CLARK Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051095

License Status

CANCELLED

Business

First Name

MICHAEL

Middle

BRENT

Last Name

CLARK

Business Name

MICHAEL BRENT CLARK

Original Issue Date

06/19/2006

Effective Date

06/19/2006

Expiration Date

06/18/2009

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006