SHANE CLARK DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001359

License Status

EXPIRED

Business

Title

First Name

SHANE

Last Name

CLARK

Business Name

SHANE CLARK DO

Original Issue Date

05/25/2020

Effective Date

05/25/2020

Expiration Date

06/24/2020

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Geriatric Medicine

Ever Disciplined

LastModifiedDate

11/19/2020