MEDICARE: DR. MERCEDES GADEA LOPEZ 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
1	208000000X	Pediatrics Physician	125.056685	IL
2	208000000X	Pediatrics Physician	ME115382	FL

General Provider Information

NPI Number	:	1750693867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERCEDES GADEA LOPEZ M.D.

Provider Business Mailing Address
First Line	:	421 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4442
Country	:	US
Telephone Number	:	561-275-1155
Fax Number	:	561-275-1156

Provider Business Practice Location Address
First Line	:	421 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4442
Country	:	US
Telephone Number	:	561-275-1155
Fax Number	:	561-275-1156

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

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	03/14/2024

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