Healthcare Provider Details

I. General information

NPI: 1710333620
Provider Name (Legal Business Name): MICHELLE LOPEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

IV. Provider business mailing address

PO BOX 531968
HARLINGEN TX
78553-1968
US

V. Phone/Fax

Practice location:
  • Phone: 833-887-4863
  • Fax: 956-296-6857
Mailing address:
  • Phone: 833-887-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS1168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: