Provider Demographics
NPI:1952389876
Name:LOPEZ, HECTOR M (MD)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4931 S 27TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2652
Mailing Address - Country:US
Mailing Address - Phone:414-546-3400
Mailing Address - Fax:414-546-3500
Practice Address - Street 1:4931 S 27TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2652
Practice Address - Country:US
Practice Address - Phone:414-546-3400
Practice Address - Fax:414-546-3500
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2012-03-05
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Provider Licenses
StateLicense IDTaxonomies
WI33647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI392004651Medicaid
WI31944500Medicaid
WI392004651Medicaid
F63327Medicare UPIN