MICHELLE T HAGSTROM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****90

License Status

NOT RENEWED

Business

First Name

MICHELLE

Middle

Last Name

HAGSTROM

Suffix

Business Name

MICHELLE T HAGSTROM MD

Original Issue Date

01/15/2008

Effective Date

07/08/2011

Expiration Date

07/31/2014

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014