MEDICARE: ASSOCIATED PHYSICIANS, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036097934	IL

General Provider Information

NPI Number	:	1265562151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED PHYSICIANS, SC

Provider Business Mailing Address
First Line	:	1405 E 12TH ST
Second Line	:	SUITE 300
City	:	MENDOTA
State	:	IL
Zip	:	61342-9010
Country	:	US
Telephone Number	:	815-539-3141
Fax Number	:	815-487-4901

Provider Business Practice Location Address
First Line	:	1405 E 12TH ST
Second Line	:	SUITE 300
City	:	MENDOTA
State	:	IL
Zip	:	61342-9011
Country	:	US
Telephone Number	:	815-539-3141
Fax Number	:	815-487-4901

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEONARDO LOPEZ
Credential	:	M.D.
Telephone Number	:	815-538-2031

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	04/04/2012

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Directions to “ASSOCIATED PHYSICIANS, SC ” Practice Location

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