STEVEN J BERGSTROM Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001243

License Status

NOT RENEWED

Business

First Name

STEVEN

Middle

Last Name

BERGSTROM

Business Name

STEVEN J BERGSTROM

Original Issue Date

10/01/1999

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

HARVARD

State

Zip

60033

County

MCHENRY

Ever Disciplined

LastModifiedDate

09/22/2010