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NPI Code Detail

MEDICARE: MR. ANTONIO LOPEZ MD

MEDICARE: MR. ANTONIO LOPEZ MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse4704289261MI
2390200000XStudent in an Organized Health Care Education/Training ProgramMI
3207R00000XInternal Medicine Physician4301513129MI
4101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1083820203
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANTONIO LOPEZ MD
Provider Business Mailing Address
First Line : 1525 CLARK ST
Second Line :
City : DETROIT
State : MI
Zip : 48209-2136
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5635 W FORT ST
Second Line :
City : DETROIT
State : MI
Zip : 48209-3154
Country : US
Telephone Number : 313-849-3920
Fax Number : 734-492-0443
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 04/01/2025

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