Organization
HENRY LOPEZ CORDERO, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY LOPEZ CORDERO M.D. (PHYSICIAN)
(847) 277-1740
Entity
Organization
Contact information
Practice address
2002 N DAMEN AVE, CHICAGO, IL 60647-4527
(773) 486-6553
Mailing address
2 WELLINGBOROUGH CT, S BARRINGTON, IL 60010-6156
(847) 277-1740
(847) 277-1744
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036048675
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00216062921
BCBS
IL
05
—
036048675
—
IL
01
—
14D0873925EFFE
CLIA
IL
Enumeration date
08/19/2010
Last updated
08/19/2010
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