EMILY M FONTAINE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036138346

License Status

NOT RENEWED

Business

Title

First Name

EMILY

Middle

Last Name

FONTAINE

Business Name

EMILY M FONTAINE MD

Original Issue Date

06/17/2015

Effective Date

06/06/2017

Expiration Date

09/30/2020

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

01/14/2021