Physician - Administrative Licensure

This license is designed for an applicant whose primary responsibilities are those of an administrative or academic nature.

The holder of an Administrative Physician license may not examine, care for, or treat patients. An Administrative Physician license does not include the authority to prescribe drugs or controlled substances, delegate medical acts, issue opinions regarding medical necessity or conduct clinical trials on humans.

Applicants for an Administrative Physician license must also meet the same qualifications for licensure as applicants applying for an unrestricted license to practice medicine and surgery

Below are some general instructions for applying for a credential on LicensE. 

1. Create or log into your LicensE account. Please visit LicensE account Information page for detailed guidance on selecting your account type.

2. Select "Apply for a License."

3. Select your Category.

4. Select your License Type.

5. Select your Application Method, then "Next."

6. Review your Personal Information.

7. Enter the requested Information on each page of the application. Information may include Examination, Education, or License History, depending on your profession.

8. If applicable, request a Veterans Fee Waiver or Initial Credential Fee Reduction.

9. Submit the requested Documents you may already have. You do not need to have all documents ready to submit.

   Note: Forms are now hosted on AccessGov. Visit AccessGov Forms Directory to choose your form.

10. Respond to the Attestation questions.

11. Provide Payment Information. Fees may be found Credential Fees.

12. Submit your application.  

Profession specific application requirements can be found in the "Application Information" section.

The application for an Administrative Physician license is not available in our LicensE software. Your application, fees, and supporting documents will need to be emailed; the instructions to upload items to LicensE do not apply to this application. Items sent through the mail will experience delays.

You will be directed to review your application checklist in our legacy software.

• Create or log into your LicensE account
• Click “Request Support” to create a new ticket
• Fill in the ticket details. Please put Administrative Physician in the License Type (Profession) and Subject lines and ask for an application to be emailed to you.
• Within approximately 10 days, you will be emailed additional instructions and an application form to fill out. This email will include Forms 570, 571, and 3071.
• Fill out Form 570, Form 571, and Form 3071 and return via email as instructed

Your application will not be present in LicensE. All supporting documents must be emailed or mailed to DSPS and should include your name clearly in the subject line. Documents can be emailed to DSPSCredMedBd@wisconsin.gov.

Questions and clarifications should be submitted as support tickets in LicensE. Email addresses provided for document submission are not monitored for support purposes. After a document is emailed, you can submit a support ticket to alert our staff.

Please Note: You are not required to provide all documents before initial application submission. You do not need to upload documents to every available category.

All candidates must request the “Practitioner Request for Information Disclosure” (Self-Query) from the National Practitioners Data Bank. After the NPDB has completed your request, they will send the Self-Query response directly to you. Once received, you will need to email the response directly to DSPSCredMedBd@wisconsin.gov.

If you have further questions regarding this report, contact the NPDB helpline at (800) 767-6732.

Reports from the American Medical Association (AMA) or American Osteopathic Association (AOA)

All MDs applying for licensure must complete the Physician Profile Data Report. This request can be made from the AMA website. You do not need to be an AMA member to request the report.

All DOs applying for licensure may use the AMA or the AOA website. AMA or AOA will send your report directly to our department.

All candidates must request the “Physician Data Center Profile” from the Federation of State Medical Boards. This request can be made from the FSMB website. FSMB will provide your report(s) directly to our department through a web portal.

National exam scores (or FCVS) – Request your national exam scores be sent directly to our department

USMLE, FLEX, and NBME – Request an electronic transcript of your USMLE scores taken at the FSMB website to be forwarded directly to DSPS.

COMLEX – Request your scores at the NBOME website and they will be forwarded directly to DSPS.

Have each facility where you have worked in the last three years compete Form 2167 and send directly to the Department. We cannot accept verification submitted by the applicant. 

If a facility is unwilling or unable to complete the form, please upload a statement to your application. Applications without all employment verifications may require additional review. 

Medical Education Verification Form (Form 2164) – Have your school complete this form and email directly to DSPSCredMedBd@wisconsin.gov.

Certificate of Post-graduate Training (Form 2165) – Have each program complete this form and email directly to DSPSCredMedBd@wisconsin.gov.

Foreign medical graduates must upload a copy to your Educational Commission for Foreign Medical Graduates (ECFMG) Certification to the application documents area.

Questions and clarifications about your application should be submitted as support tickets in LicensE. Email addresses provided for document submission are not monitored for support purposes. After a document is emailed, you can submit a support ticket to alert our staff.

Note: Not all postgraduate training programs are included in an FCVS report. Both accredited and unaccredited training programs require verification.

Have verification of your other license(s), current or expired, sent directly to us from each state where you have ever held a full license (not temporary or educational/training license). We can accept verifications directly from other state boards by email (DSPSCredMedBd@wisconsin.gov), postal mail, or VeriDoc.

Questions and clarifications about your application should be submitted as support tickets in LicensE. Email addresses provided for document submission are not monitored for support purposes. After a document is emailed, you can submit a support ticket to alert our staff.

Complete Form 1229 - Communicable Diseases Certification if you answered ‘No’ to the application Declaration question regarding state health laws related to communicable diseases. Review the laws outlined in the Wisconsin Administrative Code DHS Chapters. Email the completed form to DSPSCredMedBd@wisconsin.gov.

Questions and clarifications about your application should be submitted as support tickets in LicensE. Email addresses provided for document submission are not monitored for support purposes. After a document is emailed, you can submit a support ticket to alert our staff.

Complete Form 12829 - Physician Malpractice Suits or Claims Form (if applicable) and email the form and all required documents directly to DSPSCredMedBd@wisconsin.gov.

Questions and clarifications about your application should be submitted as support tickets in LicensE. Email addresses provided for document submission are not monitored for support purposes. After a document is emailed, you can submit a support ticket to alert our staff.

The Department accepts the physician information profile completed by FCVS through the Federation of State Medical Boards. If you choose to utilize FCVS, you may not need to submit DSPS forms to verify the following:

• Medical School Education (Form 2164);
• Post-Graduate Training (Form 2165);
• Reporting of licensure exam scores;
• Physician Data Center Profile from the Federation of State Medical Boards;
• National Practitioner Data Bank Report;
• ECFMG certificate.

You may obtain this service online at the FSMB website.

Note: The FSMB Uniform Application (UA) does not provide the same items as the FCVS report. See FSMB. Staff will match documents from FSMB when they review your application.

The following information is required to be submitted to the Board when requesting a waiver of ACGME/AOA approved postgraduate training.

License in another jurisdiction or hardship (must define what your hardship is and why it kept you from completing 2 years of ACGME/AOA approved postgraduate training). If you do not have either of these, you are not eligible to request a waiver.

A letter requesting the waiver, which must include what training and/or experience you have received and your rationale as to why the training should be considered equivalent to that provided by 24 months of an ACGME/AOA approved post graduate training program.

Completed (Form 2165) for any and all training programs you have participated in, whether it is in or outside of the U.S., provided to the Department directly from the training facility.

Optional: any other documentation related to your training/experience that the Board can use in determining equivalency (letter(s) of recommendation, explanation/details of the content of training completed, etc.).

Please note: The burden of proof of such equivalence shall lie upon the applicant.

Completed applications will be reviewed by the Medical Examining Board at the next available Board meeting. All applications are reviewed on a case-by-case basis. Equivalency cannot be determined until the file is complete and reviewed by the Board. Credentialing staff are unable to make equivalency determinations.

Applicant must complete at least one of the following:

United States Medical Licensing Examination (USMLE)

Federation Licensing Examination (FLEX)

National Board of Medical Examiners (NBME)

Comprehensive Osteopathic Medical Licensing Examination (COMLEX)

Medical Council of Canada (LMCC) endorsement (must be taken after January 1, 1978)

The oral examination must be completed if needed. Please see Wis. Admin. Code for additional information. You may be required to complete an oral exam if you:

Have a medical condition which in any way impairs or limits the applicant’s ability to practice medicine and surgery with reasonable skill and safety.

Use chemical substances so as to impair in any way the applicant’s ability to practice medicine and surgery with reasonable skill and safety.

Have been disciplined or had licensure denied by a licensing or regulatory authority in Wisconsin or another jurisdiction.

Have been found to have been negligent in the practice of medicine or has been a party in a lawsuit in which it was alleged that the applicant had been negligent in the practice of medicine.

Have been convicted of a crime the circumstances of which substantially relate to the practice of medicine.

Have lost, had reduced or had suspended his or her hospital staff privileges, or has failed to continuously maintain hospital privileges during the applicant’s period of licensure following post-graduate training.

Have been graduated from a medical school not approved by the board.

Have been diagnosed as suffering from pedophilia, exhibitionism or voyeurism.

Have engaged in the illegal use of controlled substances.

Have been subject to adverse formal action during the course of medical education, postgraduate training, hospital practice, or other medical employment.

Have not practiced medicine and surgery for a period of 3 years prior to application, unless the applicant has been graduated from a school of medicine within that period.

The oral exam process in the State of Wisconsin was created in the Wisconsin Administrative Code. If you are selected to appear for an oral exam, you will be scheduled to appear before the Review Panel at one of the regularly scheduled Board meetings. If you are selected for an oral examination, an additional oral examination fee of $266.00 will be required prior to being scheduled for this exam.

After you upload all required documents, submit your application, and pay the required fee(s):

1. Preliminary Application Reference Number (PAR)

   1. Your application will be assigned a Preliminary Application Reference number or PAR number. This number allows you and trusted parties to look up the status of your application without logging in. You can also reference this number in any support tickets you submit in regard to your application.

      • A trusted 3^rd party can look up your credential status by visiting LicensE, clicking “Application Status Lookup” and entering the PAR number you have provided to them.

2. Review Timeline

   1. Your materials will be reviewed within approximately 10 days by a member of the credentialing team.

      • Note: Some licenses do take longer to process due to complexity. You can see the performance data on our LicensE Dashboard to see what date we are reviewing for certain application types under "Application Review Times by Profession."

3. Pending Applicant Input Status

   1. After this review, if anything is missing or the credentialing team has any questions on your application, your application will go back into a status called “Pending Applicant Input.”  You will receive an email letting you know your application was moved into this status. You should then log into LicensE and check your application “Due Diligence.”

4. To check your "Due Diligence" 

   1. Your Due Diligence is a checklist of items required for your credential.

   2. The Due Diligence section is how DSPS staff will communicate with you regarding your credential requirements.

   3. Log in to your LicensE account

   4. Click on "Check Application Status" 

   5. Your credential application should be shown on this page. Under “Action” select the button that looks like an upside-down triangle. If you are on mobile, you will need to turn your phone into landscape view. Note: LicensE is best viewed on a desktop or laptop.

   6. After clicking the upside-down triangle, select “View Due Diligences.”

   7. The Due Diligence column lets you know what the requirement is.

   8. The “STATUS” column will you know if the item is “Met”, “Not Met”, or “Not Applicable.”

      • Items listed as “Not Met” are items that are needed by the Department.  

   9. The “NOTES” column of your Due Diligence will provide further written details or instructions about what is still needed.

5. To upload documents

   1. Some applications require additional document uploads.

   2. Log into your LicensE account

   3. Click on "Check Application Status"

   4. Your credential application should be shown on this page. Under "Action" select the button that looks like an upside-down triangle. If you are on mobile, you will need to turn your phone into landscape view. Note: LicensE is best viewed on a desktop or laptop. 

   5. After clicking the upside-down triangle, select "Upload Document."

   6. The document must be an allowable document type. 

   7. After uploading the document, click "submit." If you do not, it will not be sent to a reviewer. 

6. If you have any questions, you can submit a support ticket on LicensE by logging in and clicking "request support" at the top of the page.

LicensE statuses that require action from applicant:

LicensE statuses that indicate the application is with Department staff:

Support Ticket
Submit a support ticket on LicensE and click "request support." Please provide as much detail as possible regarding your concern so we can work to answer your question with a one touch resolution. 

Call
608-266-2112

Email
dsps@wisconsin.gov

Office Hours
7:45am-4:30pm
Department of Safety and Professional Services
4822 Madison Yards Way
Madison, WI, 53705

Note: The in-person office does not process same day.