Healthcare Provider Details

I. General information

NPI: 1124210646
Provider Name (Legal Business Name): DAVID A. ESTACIO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE
AURORA IL
60504-7222
US

IV. Provider business mailing address

185 PENNY AVE
EAST DUNDEE IL
60118-1454
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4860
  • Fax:
Mailing address:
  • Phone: 847-836-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: