THITAPA PETLERKWONG DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079420

License Status

CANCELLED

Business

Title

First Name

THITAPA

Last Name

PETLERKWONG

Business Name

THITAPA PETLERKWONG DO

Original Issue Date

07/01/2022

Effective Date

07/01/2022

Expiration Date

06/30/2025

City

PEORIA

State

Zip

61605

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/07/2025