Provider Demographics
NPI:1144429671
Name:PEDRO LOPEZ, M.D., LTD
Entity Type:Organization
Organization Name:PEDRO LOPEZ, M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-665-8047
Mailing Address - Street 1:PO BOX 3176
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60138-3176
Mailing Address - Country:US
Mailing Address - Phone:630-665-8047
Mailing Address - Fax:
Practice Address - Street 1:5525 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4417
Practice Address - Country:US
Practice Address - Phone:773-585-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-14
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
280360Medicare PIN