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Individual
BERTHA A LOPEZ
Active
Individual
BERTHA A LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036090643
IL
207VM0101X
Maternal & Fetal Medicine Physician
036090643
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1621924
BCBS GROUP NUMBER
IL
01
—
207667
MEDICAER GROUP NUMBER
IL
05
—
36090643
—
IL
Enumeration date
07/18/2006
Last updated
12/31/2019
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