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NPI Code Detail

MEDICARE: MR. JAVIER LOPEZ MD

MEDICARE: MR. JAVIER 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
1208600000XSurgery Physician2653301OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154319804
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAVIER LOPEZ MD
Provider Business Mailing Address
First Line : 5158 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44127-1533
Country : US
Telephone Number : 216-271-0711
Fax Number : 216-271-5473
Provider Business Practice Location Address
First Line : 5158 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44127-1533
Country : US
Telephone Number : 216-271-0711
Fax Number : 216-271-5473
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2005
Last Update Date : 07/08/2007

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