EDWARD STEPHEN BOLESTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

NOT RENEWED

Business

First Name

EDWARD

Middle

STEPHEN

Last Name

BOLESTA

Suffix

Business Name

EDWARD STEPHEN BOLESTA MD

Original Issue Date

09/11/2000

Effective Date

04/21/2014

Expiration Date

07/31/2017

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020