Healthcare Provider Details

I. General information

NPI: 1457166225
Provider Name (Legal Business Name): MICHAEL ESPERANZA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W OGDEN AVE
CHICAGO IL
60612-3765
US

IV. Provider business mailing address

8141 LAVERGNE AVE
BURBANK IL
60459-2132
US

V. Phone/Fax

Practice location:
  • Phone: 312-442-2746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041361937
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: