ETHAN PATRICK BERG DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036152387

License Status

ACTIVE

Business

Title

First Name

ETHAN

Middle

PATRICK

Last Name

BERG

Business Name

ETHAN PATRICK BERG DO

Original Issue Date

03/30/2020

Effective Date

06/22/2023

Expiration Date

07/31/2026

City

DECATUR

State

Zip

62526

County

SANGAMON

Ever Disciplined

LastModifiedDate

06/22/2023