CHARLES A BERGSTROM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

NOT RENEWED

Business

First Name

CHARLES A

Last Name

BERGSTROM

Suffix

Business Name

CHARLES A BERGSTROM MD

Original Issue Date

09/20/1985

Effective Date

09/20/1985

Expiration Date

07/31/1990

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006