SOPHIA FONTANILLA SHAKUR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036132980

License Status

NOT RENEWED

Business

Title

First Name

SOPHIA

Middle

FONTANILLA

Last Name

SHAKUR

Business Name

SOPHIA FONTANILLA SHAKUR MD

Original Issue Date

05/15/2013

Effective Date

04/16/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017