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NPI Code Detail

MEDICARE: ENRIQUE LOPEZ BA

MEDICARE: ENRIQUE LOPEZ BA
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1982171815
Entity Type Code : Individual
Provider Name (Legal Business Name) : ENRIQUE LOPEZ BA
Provider Business Mailing Address
First Line : 3843 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4623
Country : US
Telephone Number : 773-884-2297
Fax Number : 773-884-0003
Provider Business Practice Location Address
First Line : 3843 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4623
Country : US
Telephone Number : 773-884-2297
Fax Number : 773-884-0003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2018
Last Update Date : 10/29/2018

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