LINDA M PETROVICH MD (Credential# 559844) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is September 1, 2017. The license expiration date date is August 31, 2018. The license status is INACTIVE.
LINDA M PETROVICH MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.042262. The credential type is physician/surgeon. The effective date is September 1, 2017. The expiration date is August 31, 2018. The business address is 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349. The current status is inactive.
| Licensee Name | LINDA M PETROVICH MD |
| Credential ID | 559844 |
| Credential Number | 1.042262 |
| Credential Type | Physician/Surgeon |
| Business Address |
11995 Singletree Ln Ste 500 Eden Prairie MN 55344-5349 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2004-03-29 |
| Effective Date | 2017-09-01 |
| Expiration Date | 2018-08-31 |
| Refresh Date | 2018-12-04 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 449580 | CSP.0040559 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2006-09-11 | 2011-03-01 - 2013-02-28 | INACTIVE |
| Street Address | 11995 SINGLETREE LN STE 500 |
| City | EDEN PRAIRIE |
| State | MN |
| Zip Code | 55344-5349 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ira M Tyler | 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Arlene Sussman | 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Albert C Ybasco | 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Gregg P Sydow | 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Scott R Kerns | 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Jennifer Sur Gutierrez | 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Reem S Awwad | 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Alan S Muraki | 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Steven B Edson | 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Bruce J Thaler | 11995 Singletree Ln Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Richard L Toothman | 11995 Singletree Ln, Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2015-12-01 ~ 2016-11-30 |
| Christian Binder | Suite 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2012-02-01 ~ 2013-01-31 |
| Priti B Ram Md | 11995 Singletree Lane, Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2018-02-01 ~ 2019-01-31 |
| Peter D Holt | 11995 Singletree Lane, Ste 500, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2015-05-01 ~ 2016-04-30 |
| Eduard Michel | 11995 Singletree Ln, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2010-05-01 ~ 2011-04-30 |
| Richard S Chang | 11995 Singletree Ln, Eden Prairie, MN 55344-5349 | Physician/surgeon | 2010-03-01 ~ 2011-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Donald T Nicell | 11995 Singletree Lane, Eden Prairie, MN 55344 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Neuroone Medical Technologies Corp | 7599 Anagram Dr, Eden Prairie, MN 55344 | Securities - Exemptions | 2020-05-15 ~ |
| Robert Edward Stone | 11995 Singletree Lane, Ste 500, Eden Prairie, MN 55344 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Daniel James Tangert | 6400 Fallbrook Rd., Eden Prairie, MN 55344 | Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| Dmitry Bolkhovets | 11995 Singletree Ln, Eden Prairie, MN 55344 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Zinpro | 104000 Vikings Drive, Suite 240, Eden Prairie, MN 55344 | Commercial Feed | 2020-03-05 ~ 2020-12-31 |
| Michael Wallace Sentome | 11995 Singletree Lane, Suite 500, Eden Prairie, MN 55344 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Stephanie Denise Johnson | 8423 Cortland Rd, Eden Prairie, MN 55344 | Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Ashley Nicole Ingram | 11000 Optum Circle, Eden Prairie, MN 55344 | Registered Nurse | 2020-01-16 ~ 2020-08-31 |
| Colleen M Steven | 13900 Chestnut Drive # 208, Eden Prarie, MN 55344 | Registered Nurse | 2019-12-01 ~ 2020-11-30 |
| Find all Licenses in zip 55344 | |||
| City | EDEN PRAIRIE |
| Zip Code | 55344 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + EDEN PRAIRIE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Humeira M Badsha | 21520 Yorba Linda Boulevard, #g-421, Yorba Linda, CA 92887 | Physician/surgeon | ~ 1995-04-30 |
| Linda T Taylor Md | P.o. Box 8577, Jackson, WY 83002 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Linda A Waldman | 20 Christopher Ln, Guilford, CT 06437-1585 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Linda L Godfrey | 8 Sulky Ln, Glastonbury, CT 06033-3257 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Linda P Milici | 58 Seaview Ave., Branford, CT 06405 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Linda J Kirch | 117 Norwood, Buffalo, NY 14222 | Physician/surgeon | 1992-12-22 ~ 1993-12-31 |
| Linda Nagy Md | Po Box 285, Hyde Park, VT 05655 | Physician/surgeon | 2001-08-16 ~ 2002-09-30 |
| Linda J Trapkin | 404 Piercefield Dr, Solvay, NY 13209-2034 | Physician/surgeon | 2016-02-01 ~ 2017-01-31 |
| Linda S Durhan | 53 Greentree Dr, Glastonbury, CT 06033-2628 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Linda M Hillebrand | 119 Cornell Ave, Claremont, CA 91711-4602 | Physician/surgeon | 2009-08-07 ~ 2010-08-31 |
Please comment or provide details below to improve the information on LINDA M PETROVICH MD.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).