MEDICARE: HENRY LOPEZ CORDERO, M.D., S.C.

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	174400000X	Specialist	036048675	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00216062921	OTHER	IL	BCBS
3	14D0873925EFFE	OTHER	IL	CLIA

General Provider Information

NPI Number	:	1346556057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY LOPEZ CORDERO, M.D., S.C.

Provider Business Mailing Address
First Line	:	2 WELLINGBOROUGH CT
Second Line	:
City	:	S BARRINGTON
State	:	IL
Zip	:	60010-6156
Country	:	US
Telephone Number	:	847-277-1740
Fax Number	:	847-277-1744

Provider Business Practice Location Address
First Line	:	2002 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4527
Country	:	US
Telephone Number	:	773-486-6553
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. HENRY LOPEZ CORDERO
Credential	:	M.D.
Telephone Number	:	847-277-1740

Provider Enumeration Date	:	08/19/2010
Last Update Date	:	08/19/2010

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