KEVIN C PETERSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036070105

License Status

NOT RENEWED

Business

First Name

KEVIN

Middle

Last Name

PETERSEN

Suffix

Business Name

KEVIN C PETERSEN MD

Original Issue Date

01/30/1985

Effective Date

01/30/1985

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60660

County

COOK

Ever Disciplined

LastModifiedDate

04/12/2011

Case Number

2002000147

Action

Suspension

Discipline Start Date

11/13/2002

Discipline End Date

12/20/2010

Discipline Reason

Failed to file and/or pay Illinois income taxes.