STACEY A BOMGAARS Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125042599

License Status

CANCELLED

Business

First Name

STACEY

Middle

Last Name

BOMGAARS

Business Name

STACEY A BOMGAARS

Original Issue Date

06/19/2001

Effective Date

06/19/2001

Expiration Date

06/18/2005

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

09/22/2006