ETHAN PATRICK BERG DO - Medical Doctor License in Illinois | # 125071205

ETHAN PATRICK BERG DO

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125071205

License Status

CANCELLED

Business

N

Title

DO

First Name

ETHAN

Middle

PATRICK

Last Name

BERG

Business Name

ETHAN PATRICK BERG DO

Original Issue Date

06/26/2017

Effective Date

06/26/2017

Expiration Date

06/26/2020

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

05/15/2017