Provider Demographics
NPI:1225048135
Name:MARCOS A. LOPEZ, M.D, S.C.
Entity Type:Organization
Organization Name:MARCOS A. LOPEZ, M.D, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-442-8010
Mailing Address - Street 1:9005 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1017
Mailing Address - Country:US
Mailing Address - Phone:708-442-8010
Mailing Address - Fax:708-442-8009
Practice Address - Street 1:9005 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1017
Practice Address - Country:US
Practice Address - Phone:708-442-8010
Practice Address - Fax:708-442-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200135Medicare ID - Type Unspecified