Provider Demographics
NPI:1316037005
Name:LOPEZ, NICHOLAS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:LOPEZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2605 KENTUCKY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3800
Mailing Address - Country:US
Mailing Address - Phone:270-415-7653
Mailing Address - Fax:207-575-8359
Practice Address - Street 1:2601 KENTUCKY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3817
Practice Address - Country:US
Practice Address - Phone:270-443-5564
Practice Address - Fax:270-443-5549
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-12-10
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Provider Licenses
StateLicense IDTaxonomies
KY42975208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64113764Medicaid
KYK189160Medicare PIN