RICHARD MAURITZ BERGENSTAL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****56

License Status

NOT RENEWED

Business

First Name

RICHARD MAURITZ

Last Name

BERGENSTAL

Suffix

Business Name

RICHARD MAURITZ BERGENSTAL MD

Original Issue Date

01/01/1997

Expiration Date

09/01/1982

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006