PHILIP CHARLES BODENSTAB MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****82

License Status

ACTIVE

Business

First Name

PHILIP CHARLES

Last Name

BODENSTAB

Suffix

Business Name

PHILIP CHARLES BODENSTAB MD

Original Issue Date

01/01/1997

Effective Date

07/18/2023

Expiration Date

07/31/2026

City

LOMBARD

State

Zip

60148

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/18/2023