Provider Demographics
NPI:1285611988
Name:LOPEZ, CECILIA GARCIA (MD)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:GARCIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 S GENESEE RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1420
Mailing Address - Country:US
Mailing Address - Phone:810-744-3321
Mailing Address - Fax:810-744-2850
Practice Address - Street 1:3020 S GENESEE RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1420
Practice Address - Country:US
Practice Address - Phone:810-744-3321
Practice Address - Fax:810-744-2850
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICL046551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2719565Medicaid
B49473Medicare UPIN