JOSE A FONTANILLA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

First Name

JOSE A

Last Name

FONTANILLA

Business Name

JOSE A FONTANILLA

Original Issue Date

12/12/1995

Effective Date

12/12/1995

Expiration Date

07/31/1996

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006