Healthcare Provider Details

I. General information

NPI: 1326204421
Provider Name (Legal Business Name): LIZA A ESCUADRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIZA AQUINO MD

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W DIVISION ST
CHICAGO IL
60622-8151
US

IV. Provider business mailing address

1000 N WESTMORELAND RD # LL0519
LAKE FOREST IL
60045-1658
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2315
  • Fax: 312-770-3371
Mailing address:
  • Phone: 847-535-6218
  • Fax: 847-535-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036121110
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number99047952A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: