| Prohealth Medical Center | |
|
2003 Montgomery Rd Suite 106 107 Aurora IL 60504-9078 | |
| (630) 340-4211 | |
| Not Available |
| Full Name | Prohealth Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 2003 Montgomery Rd, Aurora, Illinois |
| Authorized Official Name and Position | Ivan Roger Lopez (OWNER) |
| Authorized Official Contact | 7088909115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prohealth Medical Center Po Box 6313 Aurora IL 60598-0313 Ph: (708) 890-9115 | Prohealth Medical Center 2003 Montgomery Rd Suite 106 107 Aurora IL 60504-9078 Ph: (630) 340-4211 |
| NPI Number | 1740512359 |
|---|---|
| Provider Enumeration Date | 02/06/2010 |
| Last Update Date | 09/13/2022 |
| Medicare PECOS PAC ID | 5799813523 |
|---|---|
| Medicare Enrollment ID | O20100514000309 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740512359 | NPI | - | NPPES |
| 036109448 | Medicaid | IL | |
| 36109448 | Other | IL | IL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036109448 (Illinois) | Primary |
| Provider Name | Ivan R Lopez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992845069 PECOS PAC ID: 3971552662 Enrollment ID: I20050120000278 |
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