CHARLES A BERGSTROM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036071204

License Status

NOT RENEWED

Business

First Name

CHARLES A

Last Name

BERGSTROM

Suffix

Business Name

CHARLES A BERGSTROM MD

Original Issue Date

07/22/1985

Effective Date

07/22/1985

Expiration Date

07/31/1990

City

ROCKFORD

State

Zip

61107

County

WILL

Ever Disciplined

LastModifiedDate

09/20/2006