RUSSELL MARTIN PETRAK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

ACTIVE

Business

First Name

RUSSELL MARTIN

Last Name

PETRAK

Suffix

Business Name

RUSSELL MARTIN PETRAK MD

Original Issue Date

05/13/1982

Effective Date

07/21/2023

Expiration Date

07/31/2026

City

BURR RIDGE

State

Zip

60527

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/21/2023