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General NPI Number Information
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NPI Number | 1487987707
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Entity Type | Individual
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Provider Name | ALICIA LOPEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 9760 S KEDZIE AVE SUITE 11
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-3109
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Country | US
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Telephone | 708-346-7000
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Fax | 708-346-6180
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Provider Business Mailing Address
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Address Line | 9760 S KEDZIE AVE SUITE 11
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-3109
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Country | US
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Telephone | 708-346-7000
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Fax | 708-346-6180
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.121257
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License Number State | IL
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