Provider Demographics
NPI:1346374212
Name:LOPEZ, ISIDRO A (MD,)
Entity Type:Individual
Prefix:DR
First Name:ISIDRO
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-7723
Mailing Address - Country:US
Mailing Address - Phone:305-549-6000
Mailing Address - Fax:305-549-6006
Practice Address - Street 1:1495 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7723
Practice Address - Country:US
Practice Address - Phone:305-549-6000
Practice Address - Fax:305-549-6006
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME640402080A0000X
FLME646312080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261805200Medicaid
FL373402100Medicaid
FL375128700Medicaid
FL375128700Medicaid
FLF73022Medicare UPIN