Provider Demographics
NPI:1902001787
Name:LOPEZ-PRESAS, EZEQUIEL P (MD)
Entity Type:Individual
Prefix:
First Name:EZEQUIEL
Middle Name:P
Last Name:LOPEZ-PRESAS
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:PO BOX 3680
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-3680
Mailing Address - Country:US
Mailing Address - Phone:630-834-0610
Mailing Address - Fax:
Practice Address - Street 1:200 N BERTEAU AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2966
Practice Address - Country:US
Practice Address - Phone:630-834-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology