MELINDA ELLEN STACK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059395

License Status

CANCELLED

Business

Title

First Name

MELINDA

Middle

ELLEN

Last Name

STACK

Business Name

MELINDA ELLEN STACK MD

Original Issue Date

06/24/2011

Effective Date

06/24/2011

Expiration Date

06/23/2014

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

03/24/2014