VANESSA ILIENE PETRAK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075211

License Status

CANCELLED

Business

Title

First Name

VANESSA

Middle

ILIENE

Last Name

PETRAK

Business Name

VANESSA ILIENE PETRAK MD

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2022

City

BURR RIDGE

State

Zip

60527

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/16/2019