Provider Demographics
NPI:1730293127
Name:LOPEZ, STEVEN (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E BUTTERFIELD RD
Mailing Address - Street 2:BOX 130
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:708-268-0660
Mailing Address - Fax:630-782-0564
Practice Address - Street 1:205 E BUTTERFIELD RD
Practice Address - Street 2:BOX 130
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:708-268-0660
Practice Address - Fax:630-782-0564
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000011174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL246ZC0007XOtherILLINOIS