Healthcare Provider Details

I. General information

NPI: 1588029169
Provider Name (Legal Business Name): JOHN ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7235 N HAMILTON AVE
CHICAGO IL
60645-2016
US

IV. Provider business mailing address

PO BOX 481132
NILES IL
60714-1132
US

V. Phone/Fax

Practice location:
  • Phone: 847-470-0309
  • Fax:
Mailing address:
  • Phone: 847-470-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: