MARIA MIKAELA PETRICK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

CANCELLED

Business

First Name

MARIA

Middle

MIKAELA

Last Name

PETRICK

Suffix

Business Name

MARIA MIKAELA PETRICK MD

Original Issue Date

11/19/2002

Effective Date

11/19/2002

Expiration Date

07/31/2005

City

SWANSEA

State

Zip

62226

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006