Provider Demographics
NPI:1588649719
Name:LOPEZ-VELEZ, MILAGROS (MD)
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:
Last Name:LOPEZ-VELEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:MILAGROS
Other - Last Name:LOPEZ-VELEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5534
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5534
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:216-472-2740
Practice Address - Street 1:22750 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-1574
Practice Address - Country:US
Practice Address - Phone:440-232-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-057508207R00000X
OH35.057508207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022345Medicaid
OH0752216Medicaid
OH000000125648OtherANTHEM
WV3810022345Medicaid
OH000000125648OtherANTHEM
OH0752216Medicaid
OHH056191Medicare PIN