KENNETH R PETERSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****29

License Status

NOT RENEWED

Business

First Name

KENNETH R

Last Name

PETERSEN

Suffix

Business Name

KENNETH R PETERSEN MD

Original Issue Date

05/01/1986

Effective Date

05/06/2020

Expiration Date

07/31/2023

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023