MEDICARE: EMILIO ENRIQUE 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	2085R0204X	Vascular & Interventional Radiology Physician	ME129118	FL

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	:	1881919124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIO ENRIQUE LOPEZ M.D.

Provider Business Mailing Address
First Line	:	7556 LAKE WORTH RD STE 103
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2503
Country	:	US
Telephone Number	:	561-894-1370
Fax Number	:

Provider Business Practice Location Address
First Line	:	7556 LAKE WORTH RD STE 103
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2503
Country	:	US
Telephone Number	:	561-894-1370
Fax Number	:	561-894-1372

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

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	04/10/2024

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