MICHAEL LEE CLARK DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058529

License Status

CANCELLED

Business

Title

First Name

MICHAEL

Middle

LEE

Last Name

CLARK

Business Name

MICHAEL LEE CLARK DO

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

05/11/2010