Provider Demographics
NPI:1629429808
Name:LIMA LOPEZ, MARCOS (MD)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:LIMA 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 1:1431 NE 162ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4620
Mailing Address - Country:US
Mailing Address - Phone:305-949-0999
Mailing Address - Fax:305-748-6282
Practice Address - Street 1:1431 NE 162ND ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4620
Practice Address - Country:US
Practice Address - Phone:305-949-0999
Practice Address - Fax:305-748-6282
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine