MICHAEL EDWARD PETRAVICK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125072611

License Status

EXPIRED

Business

Title

First Name

MICHAEL

Middle

EDWARD

Last Name

PETRAVICK

Business Name

MICHAEL EDWARD PETRAVICK MD

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2022

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

10/11/2022