STEVEN J BERGSTROM Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****91

License Status

NOT RENEWED

Business

First Name

STEVEN

Middle

Last Name

BERGSTROM

Business Name

STEVEN J BERGSTROM

Original Issue Date

03/30/2005

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

WOODSTOCK

State

Zip

60098

County

MCHENRY

Ever Disciplined

LastModifiedDate

04/01/2010