Obtain License

Petitions for refunds must be in writing and may be granted only if the criteria set forth in Wis. Admin. Code s. RL 4.06 are met.

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Physician (MD/DO) Re-Registration Application Packet

	Form #	Title
	2070	Application Information Form
	1542	Application for Re-Registration of License to Practice Medicine and Surgery
	1934	Work History Medicine and Surgery
	2167	Hospital, Facility and Employment Verification  Form
	2829	Malpractice Suits or Claims Form
	AMA Site	American Medical Association Physician Profile Data
	1935	Request for Physician Profile Data (required for DO only)
	571	Authorization and Waiver
	1445	Disciplinary Inquiries Report
	2600	National Practitioner Data Bank
	2252	Convictions and Pending Charges  (if applies)
	1988	Notices (Department Information)
	openbook	This is required to take the online Statutes and Rules Exam.
	Practice Specialty Codes	Practice Specialty Codes for MD/DO