Individual
DR. LUIS A LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 W DEYOUNG ST, MARION, IL 62959-1630
(618) 993-5274
Mailing address
P.O. BOX 1866, MARION, IL 62959
(618) 993-5274
(618) 993-0639
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036-103701
IL
208000000X
Pediatrics Physician
Primary
036-103701
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-103701
STATE LICENSE
IL
01
—
336-064402
ST CONTROLLED SUBSTANC
IL
Enumeration date
09/25/2006
Last updated
03/07/2023
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