Active NPI
Anthony Lopez, ATC
- Prevention Professional
- Crestwood, IL
National Provider Identifier
1891221958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 2000026450
- Practice address
- 14011 Kenton Ave
Crestwood, IL 60445-2252 - Phone
- (219) 794-4653
- NPI assigned
- May 11, 2017
- Last updated
- May 11, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 2000026450 | IL | Primary |
Addresses
Primary practice location
14011 Kenton Ave
Crestwood, IL 60445-2252
Mailing address
5750 Abbey Dr
Apt 2C
Lisle, IL 60532-2582
Phone (309) 721-6705
Other names 1
- Tony Lopez
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000026450 | IL | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494460800000",
"number": "1891221958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5750 ABBEY DR",
"address_2": "APT 2C",
"city": "LISLE",
"state": "IL",
"postal_code": "605322582",
"telephone_number": "309-721-6705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14011 KENTON AVE",
"city": "CRESTWOOD",
"state": "IL",
"postal_code": "604452252",
"telephone_number": "219-794-4653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "ANTHONY",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-11",
"last_updated": "2017-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "IL",
"license": "2000026450",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TONY",
"last_name": "LOPEZ",
"code": "5",
"type": "Other Name"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.