MICHAEL EDWARD PETRAVICK 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

MICHAEL

Middle

EDWARD

Last Name

PETRAVICK

Business Name

MICHAEL EDWARD PETRAVICK MD

Original Issue Date

06/01/2023

Effective Date

06/01/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/01/2023