KELLY BRUNGARDT STEIN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****09

License Status

ACTIVE

Business

Title

First Name

KELLY

Middle

BRUNGARDT

Last Name

STEIN

Business Name

KELLY BRUNGARDT STEIN MD

Original Issue Date

06/14/2010

Effective Date

06/13/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/13/2023