WANNAPHA PETCHKRUA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

NOT RENEWED

Business

First Name

WANNAPHA

Last Name

PETCHKRUA

Suffix

Business Name

WANNAPHA PETCHKRUA MD

Original Issue Date

03/18/1997

Effective Date

03/18/1997

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60608

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006