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
:
06/10/2022
Application#
:
784928
Name
:
Ashraf, Muddasir
Profession
:
Medicine and Surgery, MD
Address
:
Bettendorf, IA
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
$60
Application Complete
Met
6/9/22: Your application has been reviewed. This item will remain unmet until all other requirements are met. KJ
All activities and practice accounted for
Met
kj
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
rcvd via FCVS -kj
ECFMG certification
Met
Electronic Document Uploaded on 11/19/2021 12:52:37 PM; Electronic Document Uploaded on 11/19/2021 12:52:41 PM;
Physicians Profile Data Report from AOA or AMA
Met
Report Date: 11/24/2021
-AK
Physician Data Center Practitioner Profile Report (Form #1445)
Met
report date 11.22.21 --kj
-Report Date: 11/19/2021
-dd
Medical Education Verification Form (Form #2164)
Met
King Edward College- 4/2004 --kj
Certificate of Post-Graduate Training (Form #2165)
Met
Toledo- 7/2007-6/2010 kj
Received Hospital, Facility and Employer Verification Forms
Met
Trinity/Unity Point Medical- 6/2010-11/2021 --kj
Verification of state license(s) directly from State Board office(s)
Met
rcvd OH IL IA -kj
National Practitioner Data Bank Report/Self-query response
Met
Report date: 11/25/2021
mct
Social Security Number
Met
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