CARLOS RAFAEL DA FONSECA MD Medical Doctor License verification

CARLOS RAFAEL DA FONSECA MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

NOT RENEWED

Business

First Name

CARLOS

Middle

RAFAEL

Last Name

DA FONSECA

Suffix

Business Name

CARLOS RAFAEL DA FONSECA MD

Original Issue Date

10/23/2008

Effective Date

04/11/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60608

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021

Case Number

2019001780

Action

Suspension

Discipline Start Date

03/10/2020

Discipline Reason

controlled substance license indefinitely suspended for a minimum of one year due to clinical privileges being suspended at Sinai Medical Group for improper controlled substance prescribing and boundary violation with one patient.