GENENE PETTWAY RADDEN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

ACTIVE

Business

Title

First Name

GENENE

Middle

PETTWAY

Last Name

RADDEN

Business Name

GENENE PETTWAY RADDEN MD

Original Issue Date

05/18/2006

Effective Date

07/22/2023

Expiration Date

07/31/2026

City

CHAMPAIGN

State

Zip

61822

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/22/2023