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  :  09/22/2020
Application#  :  726050
Name  :  Fagbemi, Olufisayo
Profession  :  Medicine and Surgery, MD
Address  :  GREENFIELD, 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)
Application Fee Met
$75
Application Complete Met
All activities and practice accounted for Met
Certification of Legal Status Completed Met
Electronic affidavit via OLAS Met
Authorization and Waiver, signed (Form #571) Met
USMLE (Step 1, Step 2, Step 3) Met
Rec'd
Physicians Profile Data Report from AOA or AMA Met
Report Date: 08/06/20
Physician Data Center Practitioner Profile Report (Form #1445) Met
report date 9/16/20
CB
Medical Education Verification Form (Form #2164) Met
Medical College of Wisconsin: 5/25/2018

Certificate of Post-Graduate Training (Form #2165) Met
Rec'd: Ascension St. Joseph's Hospital 7/2018 - 6/2019
MCW 7/2019 - 6/2021
National Practitioner Data Bank Report/Self-query response Met
Report Date: 08/06/20
Social Security Number Met