JOSE A FONTANILLA Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125030075

License Status

EXPIRED

Business

First Name

JOSE A

Last Name

FONTANILLA

Business Name

JOSE A FONTANILLA

Original Issue Date

06/03/1993

Effective Date

06/03/1993

Expiration Date

06/30/1996

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006