Individual
IVAN R LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2003 MONTGOMERY RD, SUITE 106, AURORA, IL 60504-9078
(630) 340-4211
(630) 340-3283
Mailing address
2003 MONTGOMERY RD, SUITE 106, AURORA, IL 60504-9078
(630) 340-4211
(630) 340-3283
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036109448
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02205538
BCBS PROVIDER NUMBER
IL
05
—
036109448
—
IL
01
—
363950044
TAXID
IL
Enumeration date
02/07/2007
Last updated
06/20/2012
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