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  :  04/07/2025
Application#  :  839573
Name  :  Tachtatzis, Phaedra Maria
Profession  :  Special Licenses
Address  :  Whitefish Bay, 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
06/17/2024 NOTE: Received renewal fee. jnl ----- $160
Application Complete Met
06/17/2024 NOTE: Received renewal. 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
3/3/23 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
3/20/23 Rec'd Univ of Aberdeen 07/99 - jnl
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
6/5//23 Rec'd Oxford Teaching Hosp 08/00-08/02,
King's College Hosp 01/12-09/12 - 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
Rec'd Addenbrookes Hosp 10/07-04/10
Royal Berkshire Hosp 01/03-11/03
Northern Deanery 11/03-10/07, 04/10-12/11 (as Northumbria/Lead Employer Trust)
Royal Victoria Infirmary 08/02-01/03
Aberdeen Royal Infirmary 08/99-08/00 - 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
6/5/23 Rec'd - jnl
Hospital, Facility, and Employer Verification (Form #2167) Met
3/20/23 Rec'd St James Univ Hosp 09/12-present (Leeds Teaching Hospitals 09/12-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
03/31/23 Rec'd - 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
6/22/23 Approved by MEB - jnl
6/5/23 File scheduled to be reviewed at next Board meeting on 6/21/23 - 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
04/07/2025 NOTE: Renewal letter of need and fee received. Renewed. jnl
Curriculum Vitae (CV) Met
3/31/23 Rec'd - jnl
Send a copy of your CV to Jennifer.Lamb1@wi.gov. - jnl