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  :  03/06/2024
Application#  :  839534
Name  :  Prasad, Kondragunta Rajendra
Profession  :  Special Licenses
Address  :  Milwaukee, WI
Application Status  :  (Temporary permit 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
$160
Application Complete Met
03/07/2025 NOTE: Renewal received. jnl -----
12/20/22 Your application has been reviewed. This item will remain unmet until all other requirements are met. - jnl
All activities and practice accounted for Met
All questions answered and relevant copies attached Met
01/03/23 SSN exemption rec'd - jnl
12/20/22: No Social Security Number was submitted on the application. This information is required from all applicants. You may fax this information to our office at (608) 251-3036 OR complete the SSN Exempt Form #1051, available at https://dsps.wi.gov/Credentialing/Business/fm1051.pdf and send directly to Jennifer.Lamb1@wi.gov. - jnl
Certification of Legal Status Completed Met
Affidavit of applicant, signed Met
Authorization and Waiver, signed (Form #571) Met
01/03/23 Rec'd - jnl
12/20/22: Please complete Form #571, available at https://dsps.wi.gov/Credentialing/Health/fm571.pdf, and return to Jennifer.Lamb1@wi.gov - jnl
Medical Education Verification Form (Form #2164) Met
01/11/23 Rec'd Guntur Medical College 12/87
12/20/22: Have your school submit Form #2164 (available at https://dsps.wi.gov/Credentialing/Health/fm2164.pdf) directly to Jennifer.Lamb1@wi.gov - jnl
Certificate of Post-Graduate Training (Form #2165) Met
3/10/23 Rec'd Thomas Starzl Transplantation Inst 04/96-06/96
Government General Hospital 12/86-06/88
Sanjay Gandhi Post Grad Inst 02/93-01/96
Nizams Inst of Med Sci 02/92-02/93
Post Graduate Inst of Med Ed 07/88-06/91
Post Graduate Inst of Med Ed 08/91-12/91
Queen Elizabeth Hosp 06/00-08/00
Hartlepool General Hosp 02/97-09/97
Freeman Hospital 10/97-09/98
St. James Univ Hosp 09/98-05/00 - jnl

12/20/22: Have each facility complete Form #2165 (available at https://dsps.wi.gov/Credentialing/Health/fm2165.pdf) and send directly to Jennifer.Lamb1@wi.gov - jnl
Signed letter from president or dean of WI med school, facility or college indicating applicant intends to teach, research or practice medicine and surgery Met
3/3/23 Rec'd - jnl
Hospital, Facility, and Employer Verification (Form #2167) Met
3/10/23 Rec'd Leeds Teaching Hospitals 09/00-present - jnl
12/20/22: Have facility complete Form #2167 (available at https://dsps.wi.gov/Credentialing/Health/fm2167.pdf) and send directly to Jennifer.Lamb1@wi.gov - jnl
Verification of state license(s) directly from State Board office(s) Met
3/3/23 Rec'd UK, India - jnl
12/28/22 Visiting Physicians must provide Documentary evidence of licensure to practice medicine and surgery. Have verification of a state or foreign license sent directly to Jennifer.Lamb1@wi.gov. - jnl
Oral Exam to be determined after application is completed Met
4/20/23 Approved by board. Visiting Physician License issued for one year. - jnl
12/20/22 After your completed application is received by the Department, it will be reviewed by two (2) Members of the Board. Upon approval,
you will be issued a Visiting Physician License, valid for one (1) year and remaining valid only while the license holder is actively
engaged in teaching, researching, or practicing medicine and surgery, and is lawfully entitled to work in the United States. This may be
renewed at the discretion of the Board. - jnl
Additional Comments Met
03/06/2024 NOTE: Received renewal. jnl
Curriculum Vitae (CV) Met
3/10/23 Rec'd - jnl
Send a copy of your CV to Jennifer.Lamb1@wi.gov. - jnl