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General NPI Number Information
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NPI Number | 1740512359
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Entity Type | Organization
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Legal Business Name | IVAN R LOPEZ MD PC
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Dates
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Enumeration Date | 02/06/2010
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 2003 MONTGOMERY RD SUITE 106 107
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City | AURORA
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State | IL
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Zip | 60504-9078
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Country | US
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Telephone | 630-340-4211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6313
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City | AURORA
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State | IL
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Zip | 60598-0313
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Country | US
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Telephone | 708-890-9115
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Fax | 630-340-3283
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Authorized Official
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Title or Position | OWNER
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Name | IVAN ROGER LOPEZ
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Credential | MD
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Telephone | 708-890-9115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036109448
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License Number State | IL
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