MEDICARE: DR. WILCANOR 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	208D00000X	General Practice Physician	ACN1663	PR

General Provider Information

NPI Number	:	1457098253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILCANOR LOPEZ MD

Provider Business Mailing Address
First Line	:	931 W OAK ST STE 103
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4973
Country	:	US
Telephone Number	:	407-931-0444
Fax Number	:	407-962-4446

Provider Business Practice Location Address
First Line	:	2330 NORTH BLVD W
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8989
Country	:	US
Telephone Number	:	407-931-0444
Fax Number	:	407-962-4446

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

Provider Enumeration Date	:	05/13/2022
Last Update Date	:	03/07/2025

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