Provider Demographics
NPI:1184693244
Name:LOPES, DEMETRIUS K (MD)
Entity type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:K
Last Name:LOPES
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 1:1700 LUTHER LANE
Mailing Address - Street 2:SUITE 1170
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:844-376-3876
Mailing Address - Fax:847-723-2041
Practice Address - Street 1:1700 LUTHER LANE
Practice Address - Street 2:SUITE 1170
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:844-376-3876
Practice Address - Fax:847-723-2041
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105112207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361051121Medicaid
ILL87089Medicare ID - Type Unspecified
H43558Medicare UPIN