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PETRUCCI, MICHAEL DAVID       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: QUANTUM MEDICAL RADIOLOGY USTELERADIOLOGY
1175 PEACHTREE ST NE
100 COLONY SQUARE #1425
ATLANTA GA 30361

Address last updated on 9/14/2010
Phone #: (404) 870-2807
Fax #:
County: NOT OKLAHOMA
License: 27942
Dated: 9/14/2010
Expires: 9/1/2011
Temp. Lic. Issued: 9/3/2010
Temp. Lic. Expires: 11/6/2010
License Type: Medical Doctor
Specialty: Diagnostic Radiology
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: G WASHINGTON UNIV SCH MED & HLTH SCI, WASHINGTON DC 20037
Graduated: 6 / 1997
CME Year: 2013
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications: AMERICAN BOARD OF NUCLEAR MEDICINE
AMERICAN BOARD OF RADIOLOGY
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
QUANTUM MEDICAL RADIOLOGY USTELERADIOLOGY
1175 PEACHTREE ST NE
100 COLONY SQUARE #1425
ATLANTA GA 30361

Phone #: (404) 870-2807
Fax #:

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