Wisconsin Department of Safety and Professional Services
Health & Business Renewal Application
Application Status Query
Instructions:
Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.
Please verify the checklist information below, including your address. If your address has changed, please
e-mail
your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.
As of
:
10/06/2009
Application#
:
323354
Name
:
McKenna, Patrick A
Profession
:
Medicine and Surgery, MD
Address
:
Antigo, WI
Application Status
:
(Permanent license issued)
Requirements Not Met:
Description
Status
Comments (Please note, not all requirements will include comments)
Requirements Met:
Description
Status
Comments (Please note, not all requirements will include comments)
WI Statute & Rules Examination
Met
PASSED
Social Security Number
Met
Application Fee
Met
Pd 10/29/08 $
Pages One and Two - Applicable blanks completed
Met
Pre-Professional and Professional Education
Met
All activities and practice accounted for
Met
Pages Three, Four and Five - Applicable blanks completed
Met
Affidavit of applicant, signed
Met
USMLE Step 1, Step 2 scores
Met
USMLE Step 3 score (after exam)
Met
PASSED
USMLE application received
Met
USMLE application mailed to FSMB
Met
Authorization and Waiver, signed (Form #571)
Met
Copy of Medical diploma
Met
Certification of Legal Status Completed
Met
Medical Education Verification Form (Form #2164)
Met
Graduated 5/08
Certificate of Post-Graduate Training (Form #2165) Need after passing Step 3.
Met
National Practitioner Data Bank Report/Self-query
Met
Report date 9/14/09
Login
Application Status
DSPS Home Page
License Look-up
Main Menu
PIN Look-up