Individual
ELENA R LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1940 W 18TH ST FL 1, CHICAGO, IL 60608-1903
(773) 254-1400
Mailing address
966 W 21ST ST, CHICAGO, IL 60608-4511
(773) 254-1400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-104170
IL
207Q00000X
Family Medicine Physician
2015030335
MO
207Q00000X
Family Medicine Physician
C149479
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104170
—
IL
Enumeration date
02/02/2006
Last updated
06/20/2022
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