Healthcare Provider Details

I. General information

NPI: 1770900185
Provider Name (Legal Business Name): ANTHONY JOSEPH ESPOSITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 18-250
CHICAGO IL
60611-5980
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 18-250
CHICAGO IL
60611-5980
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-1800
  • Fax: 312-695-4741
Mailing address:
  • Phone: 312-695-1800
  • Fax: 312-695-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036155386
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: