MEDICARE: SHEREE L 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
1	207Q00000X	Family Medicine Physician	35.080590	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1376528661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEREE L LOPEZ MD

Provider Business Mailing Address
First Line	:	6096 E MAIN ST
Second Line	:	SUITE 102
City	:	COLUMBUS
State	:	OH
Zip	:	43213-4302
Country	:	US
Telephone Number	:	614-577-0400
Fax Number	:	614-577-0040

Provider Business Practice Location Address
First Line	:	6096 E MAIN ST
Second Line	:	SUITE 102
City	:	COLUMBUS
State	:	OH
Zip	:	43213-4302
Country	:	US
Telephone Number	:	614-577-0400
Fax Number	:	614-577-0040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	04/23/2013

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