JENNIFER L BERGQUIST Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044264

License Status

CANCELLED

Business

First Name

JENNIFER

Middle

Last Name

BERGQUIST

Business Name

JENNIFER L BERGQUIST

Original Issue Date

06/24/2002

Effective Date

06/24/2002

Expiration Date

06/23/2005

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006