STEFAN MICHAEL BUMOL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

NOT RENEWED

Business

Title

First Name

STEFAN

Middle

MICHAEL

Last Name

BUMOL

Business Name

STEFAN MICHAEL BUMOL MD

Original Issue Date

06/29/2017

Effective Date

06/29/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021