SOPHIA FONTANILLA SHAKUR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****97

License Status

NOT RENEWED

Business

Title

First Name

SOPHIA

Middle

FONTANILLA

Last Name

SHAKUR

Business Name

SOPHIA FONTANILLA SHAKUR MD

Original Issue Date

05/15/2013

Effective Date

04/12/2016

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60601

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017