SOPHIA FONTANILLA SHAKUR MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055943

License Status

CANCELLED

Business

Title

First Name

SOPHIA

Middle

FONTANILLA

Last Name

SHAKUR

Business Name

SOPHIA FONTANILLA SHAKUR MD

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Neurological Surgery

Ever Disciplined

LastModifiedDate

04/03/2012