LARA MARCELLA MACK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004049

License Status

ACTIVE

Business

First Name

LARA

Middle

MARCELLA

Last Name

MACK

Business Name

LARA MARCELLA MACK

Original Issue Date

07/01/2011

Effective Date

12/06/2025

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60622

County

COOK

Ever Disciplined

LastModifiedDate

12/06/2025