MARK JAY MCGILLEM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036127983

License Status

NOT RENEWED

Business

First Name

MARK

Middle

JAY

Last Name

MCGILLEM

Suffix

Business Name

MARK JAY MCGILLEM MD

Original Issue Date

06/01/2011

Effective Date

06/01/2011

Expiration Date

07/31/2014

City

SOUTH BEND

State

Zip

46616

County

INDIANA

Ever Disciplined

LastModifiedDate

11/17/2014