JAVIER FONSECA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****71

License Status

NOT RENEWED

Business

First Name

JAVIER

Last Name

FONSECA

Suffix

Business Name

JAVIER FONSECA MD

Original Issue Date

01/01/1997

Effective Date

07/14/2011

Expiration Date

07/31/2014

City

LONG GROVE

State

Zip

60047

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014