Provider Demographics
NPI:1558306647
Name:LAUREN S. LOPEZ MD SC
Entity Type:Organization
Organization Name:LAUREN S. LOPEZ MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-328-8798
Mailing Address - Street 1:10201 W LINCOLN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2136
Mailing Address - Country:US
Mailing Address - Phone:414-328-8798
Mailing Address - Fax:
Practice Address - Street 1:10201 W LINCOLN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2136
Practice Address - Country:US
Practice Address - Phone:414-328-8798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28257207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21256000Medicaid
WI21256000Medicaid