MICHAEL J PETERSEN DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****06

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

Last Name

PETERSEN

Suffix

DPM

Business Name

MICHAEL J PETERSEN DPM

Original Issue Date

01/01/1998

Effective Date

12/09/2014

Expiration Date

01/31/2017

City

MCHENRY

State

Zip

60050

County

MCHENRY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/27/2017