Healthcare Provider Details

I. General information

NPI: 1083820203
Provider Name (Legal Business Name): ANTONIO LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANTONIO LOPEZ CASTANEDA MD

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 BROMBACH ST
HAMTRAMCK MI
48212-3473
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 313-972-9000
  • Fax:
Mailing address:
  • Phone: 313-874-2892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704289261
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301513129
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: