Healthcare Provider Details

I. General information

NPI: 1023376746
Provider Name (Legal Business Name): MICHAEL ALONZO LOPEZ M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 6TH AVE S # CHB314
BIRMINGHAM AL
35233
US

IV. Provider business mailing address

1 BAYLOR PLZ BCM 320
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-7850
  • Fax:
Mailing address:
  • Phone: 281-488-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number37283
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number37283
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: