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NPI Code Detail

MEDICARE: MARCO ANTONIO LOPEZ VELAZQUEZ M.D.

MEDICARE: MARCO ANTONIO LOPEZ VELAZQUEZ M.D.
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
1207RR0500XRheumatology PhysicianU2721TX
2208M00000XHospitalist PhysicianU2721TX
3207R00000XInternal Medicine PhysicianU2721TX

General Provider Information

NPI Number : 1316399264
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCO ANTONIO LOPEZ VELAZQUEZ M.D.
Provider Business Mailing Address
First Line : 180 HARVESTER DR STE 110
Second Line :
City : BURR RIDGE
State : IL
Zip : 60527-6686
Country : US
Telephone Number : 773-702-1150
Fax Number :
Provider Business Practice Location Address
First Line : 7500 RIALTO BLVD STE 1-140
Second Line :
City : AUSTIN
State : TX
Zip : 78735-8534
Country : US
Telephone Number : 312-385-0441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2016
Last Update Date : 11/12/2024

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