MEDICARE: DR. FREDDY A ESCORCIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	036092303	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558346544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDDY A ESCORCIA M.D.

Provider Business Mailing Address
First Line	:	117 HEATHERVIEW DR
Second Line	:
City	:	EAST PEORIA
State	:	IL
Zip	:	61611-4890
Country	:	US
Telephone Number	:	309-387-2733
Fax Number	:	309-387-2733

Provider Business Practice Location Address
First Line	:	117 HEATHERVIEW DR
Second Line	:
City	:	EAST PEORIA
State	:	IL
Zip	:	61611-4890
Country	:	US
Telephone Number	:	309-387-2733
Fax Number	:	309-387-2733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	02/07/2011

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