CRYSTAL TENNILLE CLARK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

ACTIVE

Business

Title

First Name

CRYSTAL

Middle

TENNILLE

Last Name

CLARK

Business Name

CRYSTAL TENNILLE CLARK MD

Original Issue Date

10/05/2012

Effective Date

07/18/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/18/2023