STACIE LAUREN CLARK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068055

License Status

EXPIRED

Business

Title

First Name

STACIE

Middle

LAUREN

Last Name

CLARK

Business Name

STACIE LAUREN CLARK MD

Original Issue Date

07/01/2016

Effective Date

07/01/2016

Expiration Date

06/30/2019

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

10/02/2019