License holder summary

SOUTHLAKE SURG is a Medical Licensing Board - Medical Corporation licensed to practice in Indiana. The address on file for SOUTHLAKE SURG is CLINIC INC, 151 SHORE DRIVE R R 642, PORTAGE IN 46368. This licensed professional license is not current. The license was granted 10/24/1968 and expired on 01/31/1992.

Indiana

Professional Licensing Agency

SOUTHLAKE SURG
Medical Licensing Board - Medical Corporation
License number
50000036A
Date granted
10/24/1968
Date expires
01/31/1992
Class
Medical Licensing Board - Medical Corporation
Status
Expired
Address
CLINIC INC, 151 SHORE DRIVE R R 642, PORTAGE IN 46368
indianalicensing.org
ID 24833097
LAST UPDATED 2026-09-13 06:30:13 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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