DANIEL WILLIAM BERGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036122423

License Status

NOT RENEWED

Business

First Name

DANIEL

Middle

WILLIAM

Last Name

BERGNER

Suffix

Business Name

DANIEL WILLIAM BERGNER MD

Original Issue Date

01/08/2009

Effective Date

04/15/2014

Expiration Date

07/31/2017

City

GRAND RAPIDS

State

Zip

49546

Ever Disciplined

LastModifiedDate

02/08/2018

Case Number

2017006932

Action

Suspension

Discipline Start Date

10/06/2017

Discipline End Date

12/08/2017

Discipline Reason

Failure to file and/or pay Illinois state income taxes. Notice of tax deficiency release received from Department of Revenue on 12/12/2017.