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General NPI Number Information
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NPI Number | 1467452300
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Entity Type | Individual
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Provider Name | EUGENE P LOPEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 901 BIESTERFIELD RD SUITE 300
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3392
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Country | US
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Telephone | 847-437-9889
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Fax | 847-437-4149
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Provider Business Mailing Address
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Address Line | PO BOX 807
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60009-0807
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Country | US
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Telephone | 847-437-9889
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Fax | 847-437-4149
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State | IL
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