CHANNING S PETRAK Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036108511

License Status

ACTIVE

Business

First Name

CHANNING

Middle

Last Name

PETRAK

Business Name

CHANNING S PETRAK

Original Issue Date

01/30/2003

Effective Date

05/31/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61603

County

PEORIA

Ever Disciplined

LastModifiedDate

05/31/2023