Provider Demographics
NPI:1154453397
Name:LOPEZ, FRANK ANTOLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ANTOLIN
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:121 S PHELPS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5200
Mailing Address - Country:US
Mailing Address - Phone:407-678-1822
Mailing Address - Fax:407-644-6101
Practice Address - Street 1:1992 MIZELL AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4117
Practice Address - Country:US
Practice Address - Phone:407-644-4844
Practice Address - Fax:407-644-6101
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME544572080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0407010400Medicaid