SHALE JACOB MACK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125083402

License Status

ACTIVE

Business

Title

First Name

SHALE

Middle

JACOB

Last Name

MACK

Business Name

SHALE JACOB MACK MD

Original Issue Date

06/24/2024

Effective Date

06/24/2024

Expiration Date

06/23/2027

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

04/05/2024