THITAPA PETLERKWONG DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****68

License Status

ACTIVE

Business

Title

First Name

THITAPA

Last Name

PETLERKWONG

Business Name

THITAPA PETLERKWONG DO

Original Issue Date

03/07/2025

Effective Date

03/07/2025

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/07/2025