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Individual
IVAN R LOPEZ
Active
Individual
IVAN R LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036109448
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02205538
BCBS PROVIDER NUMBER
IL
05
—
036109448
—
IL
01
—
363950044
TAXID
IL
Enumeration date
02/07/2007
Last updated
06/20/2012
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