MEDICARE: ELENA R 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	2015030335	MO
2	207Q00000X	Family Medicine Physician	C149479	CA
3	207Q00000X	Family Medicine Physician	036-104170	IL

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	:	1831161132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA R LOPEZ MD

Provider Business Mailing Address
First Line	:	966 W 21ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4511
Country	:	US
Telephone Number	:	773-254-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 W 18TH ST FL 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1903
Country	:	US
Telephone Number	:	773-254-1400
Fax Number	:

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	06/20/2022

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Directions to “ ELENA R LOPEZ MD” Practice Location

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