MAGALI J FONTAINE 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

MAGALI

Middle

Last Name

FONTAINE

Business Name

MAGALI J FONTAINE

Original Issue Date

09/11/1995

Effective Date

09/11/1995

Expiration Date

07/31/1996

City

CHICAGO

State

Zip

60612

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006