STACEY A BOMGAARS Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****13

License Status

NOT RENEWED

Business

First Name

STACEY

Middle

Last Name

BOMGAARS

Business Name

STACEY A BOMGAARS

Original Issue Date

04/06/2005

Effective Date

04/06/2005

Expiration Date

07/31/2008

City

EVANSTON

State

Zip

60201

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008