Provider Demographics
NPI:1194921395
Name:LOPATA, HOWARD I (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:I
Last Name:LOPATA
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 1:450 ANJOU DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2211
Mailing Address - Country:US
Mailing Address - Phone:847-498-1594
Mailing Address - Fax:847-498-1509
Practice Address - Street 1:450 ANJOU DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2211
Practice Address - Country:US
Practice Address - Phone:847-498-1594
Practice Address - Fax:847-498-1509
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL338570Medicare ID - Type Unspecified