MEDICARE: MIGUEL GONZALO LOPEZ IV

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	101YP2500X	Professional Counselor	80456	TX

General Provider Information

NPI Number	:	1558721795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL GONZALO LOPEZ IV

Provider Business Mailing Address
First Line	:	4214 CALMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-4311
Country	:	US
Telephone Number	:	956-648-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	4214 CALMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-4311
Country	:	US
Telephone Number	:	956-648-9222
Fax Number	:

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

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	12/10/2024

Similar Medicare Providers

1407843626 — VENKAT NAMBURU MD PA
Practice Location Address:

7633 BELLAIRE DR S , SUITE 105
FORT WORTH, TX
76132-4311

Practice Phone: 817-386-5767
Practice Fax: 817-386-5857

1740233543 — MICHAEL L. RICHEY MD
Practice Location Address:

7633 BELLAIRE DR S STE 117
FORT WORTH, TX
76132-4311

Practice Phone: 817-566-0663
Practice Fax: 817-346-2564

1124172010 — DR. VENKAT ESWARA-RAO NAMBURU M.D.
Practice Location Address:

7633 BELLAIRE DR S , SUITE 105
FORT WORTH, TX
76132-4311

Practice Phone: 817-386-5767
Practice Fax: 817-386-5857

1902925514 — TEXAS ORTHOTIC AND PROSTHETIC SYSTEMS, INC.
Practice Location Address:

1226 S LAKE ST
FORT WORTH, TX
76104-4311

Practice Phone: 817-810-0901
Practice Fax: 817-810-0903

1477728079 — DR. BIBI TASLEYMA SATTAR DO
Practice Location Address:

7633 BELLAIRE DR S STE 121
FORT WORTH, TX
76132-4311

Practice Phone: 817-346-3366
Practice Fax: 817-346-3710

1740587807 — DR. KEVIN CARSTEN SYKES D.C.
Practice Location Address:

7633 BELLAIRE DR S STE 101
FORT WORTH, TX
76132-4311

Practice Phone: 817-349-7541
Practice Fax: 817-349-7549

Directions to “ MIGUEL GONZALO LOPEZ IV ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.