CHANNING S PETRAK Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****75

License Status

ACTIVE

Business

First Name

CHANNING

Middle

Last Name

PETRAK

Business Name

CHANNING S PETRAK

Original Issue Date

02/03/2003

Effective Date

05/31/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61603

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/31/2023