CARLOS RAFAEL DA FONSECA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051296

License Status

CANCELLED

Business

First Name

CARLOS

Middle

RAFAEL

Last Name

DA FONSECA

Suffix

Business Name

CARLOS RAFAEL DA FONSECA MD

Original Issue Date

07/01/2006

Effective Date

07/01/2006

Expiration Date

06/30/2009

City

CHICAGO

State

Zip

60608

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006