STACEY A BOMGAARS Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036113298

License Status

NOT RENEWED

Business

First Name

STACEY

Middle

Last Name

BOMGAARS

Business Name

STACEY A BOMGAARS

Original Issue Date

03/21/2005

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60640

County

COOK

Ever Disciplined

LastModifiedDate

11/06/2008