Organization
MARION PEDIATRIC CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS A LOPEZ MD (PRESIDENT)
(618) 993-5274
Entity
Organization
Contact information
Practice address
3331 W DEYOUNG ST STE 207, MARION, IL 62959-5897
(618) 993-5274
(618) 993-0639
Mailing address
3331 W DEYOUNG ST STE 207, MARION, IL 62959-5897
(618) 993-5274
(618) 993-0639
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036103701
IL
Other
Enumeration date
06/21/2010
Last updated
06/21/2010
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