License holder summary

Kenneth D. Petersen is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Kenneth D. Petersen is Fairhaven Obstetrics & Gynecology, 1111 Lighthouse Lane, Goshen IN 46526-3824. This licensed professional license is not current. The license was granted 07/31/1986 and expired on 10/31/2013.

Indiana

Professional Licensing Agency

Kenneth D. Petersen
Controlled Substance Registration - Physician
License number
01028273B
Date granted
07/31/1986
Date expires
10/31/2013
Class
Controlled Substance Registration - Physician
Status
Expired
Address
Fairhaven Obstetrics & Gynecology, 1111 Lighthouse Lane, Goshen IN 46526-3824
indianalicensing.org
ID 5858797
LAST UPDATED 2026-05-21 15:21:27 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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