Individual
JOHN M LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-7000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39763-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32468500
—
WI
Enumeration date
07/25/2006
Last updated
09/16/2024
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