Individual
LEONARDO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1311 MEMORIAL DR STE 500, MENDOTA, IL 61342-3013
(815) 539-3141
(815) 487-4901
Mailing address
1311 MEMORIAL DR STE 500, MENDOTA, IL 61342-3013
(815) 539-3141
(815) 538-1838
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036098968
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036098968
LICENSE
IL
01
—
336059388
CONTROLLED SUB. LICENSE
IL
Enumeration date
09/23/2006
Last updated
03/07/2023
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