DWAIN CLARK ILLMAN MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036047572

License Status

INACTIVE

Business

First Name

DWAIN CLARK

Last Name

ILLMAN

Suffix

Business Name

DWAIN CLARK ILLMAN MD

Original Issue Date

07/20/1973

Effective Date

07/20/1973

Expiration Date

07/31/1990

City

BLOOMINGTON

State

Zip

47401

County

INDIANA

Ever Disciplined

LastModifiedDate

09/20/2006