WILLIAM R BERTELSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036028802

License Status

NOT RENEWED

Business

First Name

WILLIAM

Middle

Last Name

BERTELSEN

Suffix

Business Name

WILLIAM R BERTELSEN MD

Original Issue Date

08/16/1948

Effective Date

05/15/2008

Expiration Date

07/31/2011

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

12/11/2013

Case Number

2011006681

Action

Suspension

Discipline Start Date

10/14/2011

Discipline End Date

12/09/2013

Discipline Reason

Failure to file and/or pay Illinois state income taxes. Notice of tax deficiency release received from Department of Revenue on 12/11/2013.