Individual
MANUEL EMILIO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226
(618) 257-6220
(618) 257-6679
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
(618) 257-6679
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-147907
IL
207R00000X
Internal Medicine Physician
9401258
NC
208M00000X
Hospitalist Physician
Primary
036-147907
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8952841
—
NC
Enumeration date
07/15/2005
Last updated
03/25/2021
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