STEPHEN DALE BOVENKERK DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045949

License Status

CANCELLED

Business

First Name

STEPHEN

Middle

DALE

Last Name

BOVENKERK

Suffix

Business Name

STEPHEN DALE BOVENKERK DO

Original Issue Date

07/01/2003

Effective Date

07/01/2003

Expiration Date

06/30/2006

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006