KENNETH R PETERSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

NOT RENEWED

Business

First Name

KENNETH R

Last Name

PETERSEN

Suffix

Business Name

KENNETH R PETERSEN MD

Original Issue Date

07/25/1996

Effective Date

07/25/1996

Expiration Date

07/31/1999

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020