JAVIER FONSECA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036047883

License Status

NOT RENEWED

Business

First Name

JAVIER

Last Name

FONSECA

Suffix

Business Name

JAVIER FONSECA MD

Original Issue Date

08/23/1973

Effective Date

07/14/2011

Expiration Date

07/31/2014

City

LONG GROVE

State

Zip

60047

County

LAKE

Ever Disciplined

LastModifiedDate

11/17/2014