Basic Information
| Provider Information | |||||||||
| NPI: | 1588649719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOPEZ-VELEZ | ||||||||
| FirstName: | MILAGROS | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LOPEZ-VELEZ | ||||||||
| OtherFirstName: | JUANITA | ||||||||
| OtherMiddleName: | MILAGROS | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 5534 | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601975534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403744500 | ||||||||
| FaxNumber: | 2164722740 | ||||||||
| Practice Location | |||||||||
| Address1: | 22750 ROCKSIDE RD | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441461574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402329800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 09/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-057508 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 35.057508 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 3810022345 | 05 | WV | MEDICAID | 0752216 | 05 | OH | MEDICAID | 000000125648 | 01 | OH | ANTHEM | OTHER |