JASON NATHANIEL MACKLIS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058065

License Status

CANCELLED

Business

Title

First Name

JASON

Middle

NATHANIEL

Last Name

MACKLIS

Business Name

JASON NATHANIEL MACKLIS MD

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/04/2010