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Organization
IVAN R LOPEZ MD PC
Active
Organization
IVAN R LOPEZ MD PC
Active
Parent organization
IVAN R LOPEZ MD PC
Other names
ProHealth Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
IVAN R LOPEZ MD PC
Authorized official
IVAN ROGER LOPEZ MD (OWNER)
(708) 890-9115
Entity
Organization
Contact information
Practice address
2003 MONTGOMERY RD, SUITE 106 107, AURORA, IL 60504-9078
(630) 340-4211
Mailing address
PO BOX 6313, AURORA, IL 60598-0313
(708) 890-9115
(630) 340-3283
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036109448
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036109448
—
IL
01
—
36109448
IL LICENSE
IL
Enumeration date
02/06/2010
Last updated
09/13/2022
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