BRIAN K BREDVIK (Credential# 1121115) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.
BRIAN K BREDVIK is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.051412. The credential type is physician/surgeon. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 3640 Main St Ste 205, Springfield, MA 01107-1139. The current status is active.
| Licensee Name | BRIAN K BREDVIK |
| Credential ID | 1121115 |
| Credential Number | 1.051412 |
| Credential Type | Physician/Surgeon |
| Business Address |
3640 Main St Ste 205 Springfield MA 01107-1139 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2012-09-24 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-03-16 |
| Street Address | 3640 MAIN ST STE 205 |
| City | SPRINGFIELD |
| State | MA |
| Zip Code | 01107-1139 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mark A Jackowitz | 3640 Main St Ste 205, Springfield, MA 01107-1139 | Physician/surgeon | 2020-01-01 ~ 2020-12-31 |
| Philip Moraitis | 3640 Main St Ste 205, Springfield, MA 01107-1139 | Physician/surgeon | 2016-05-01 ~ 2017-04-30 |
| Gregory J Faust | 3640 Main St Ste 205, Springfield, MA 01107-1139 | Physician/surgeon | 2014-04-01 ~ 2015-03-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Susan D Glover | 3640 Main Street, Springfield, MA 01107-1139 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Phillip S Kick | 3640 Main St Ste 103, Springfield, MA 01107-1139 | Physician/surgeon | 2016-04-01 ~ 2017-03-31 |
| William C Tran | 3640 Main St Ste 103, Springfield, MA 01107-1139 | Physician/surgeon | 2014-08-01 ~ 2015-07-31 |
| Raphael J De Lima | 3640 Main Street, Springfield, MA 01107-1139 | Physician/surgeon | 2008-10-14 ~ 2009-10-31 |
| Mohammad R Mostafavi | 3640 Main St Ste 103, Springfield, MA 01107-1139 | Physician/surgeon | ~ |
| Donald J Sonn | 3640 Main St Ste 103, Springfield, MA 01107-1139 | Physician/surgeon | ~ |
| Alexander M. Berry | 3640 Main St Ste 103, Springfield, MA 01107-1139 | Physician/surgeon | ~ |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Lauren Elizabeth Marshall | 945 Armory St, Springfield, MA 01107 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Jennifer L Fish | 367 Union Street, Springfield, MA 01107 | Hairdresser/cosmetician | ~ |
| Joseph Pagan | 59 Rowland Street, Springfield, MA 01107 | Medication Administration Certification | 2020-04-20 ~ 2022-04-19 |
| Daniel Laguerre | 382 Springfield St, Springfield, MA 01107 | Crane Operator | ~ |
| Kamal Kant Kalia | 2 Medical Center Drive, Springfield, MA 01107 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Bushee Enterprises LLC | Po Box 1196, Southwick, MA 01107 | Home Improvement Contractor | 2015-12-01 ~ 2016-11-30 |
| B Lopez | 165 Prospect Street, Springfield, MA 01107 | Notary Public Appointment | 2011-10-01 ~ 2016-09-30 |
| Beth C Mcinerny | 260 Ware Road, Belchertown, MA 01107 | Registered Nurse | 2019-12-01 ~ 2020-11-30 |
| Jorge Enrique Rivera | 20 Narragansett Street, Springfield, MA 01107 | Professional Counselor | 2019-10-01 ~ 2020-09-30 |
| Rachael Hynds-decoteau | 22 Candice Cir, Springfield, MA 01107 | Controlled Substance Registration for Practitioner | 2019-09-19 ~ 2021-02-28 |
| Find all Licenses in zip 01107 | |||
| City | SPRINGFIELD |
| Zip Code | 01107 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + SPRINGFIELD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Brian W King | Po Box 23, Willimantic, CT 06226-0023 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| David Brian Feig | 701 5th Ave, Seattle, WA 98104 | Physician/surgeon | ~ |
| Brian A. Lipari | Po Box 87, Islip, NY 11751-0087 | Physician/surgeon | 2013-12-01 ~ 2014-11-30 |
| Brian B. Koo | 575 Lambert Rd, Orange, CT 06477-2403 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Brian M Keegan | 200 1st St Sw, Rochester, MN 55905-0001 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Brian J Rosenthal | Po Box 839, New Milford, CT 06776 | Physician/surgeon | 2016-05-01 ~ 2017-04-30 |
| Brian A Crum | 200 1st St Sw, Rochester, MN 55905-0001 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Brian Cohen | 58 Hilltop Cir, Milford, CT 06460-7526 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Brian G Tobin | 303 Whitney Ave, New Haven, CT 06511-3765 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Brian Rank | 178 9th St E Ste 300, Saint Paul, MN 55101-2317 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).