Healthcare Provider Details

I. General information

NPI: 1932154937
Provider Name (Legal Business Name): CARLOS H ESCAMILLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CARLOS H ESCAMILLA RIVERA M.D.

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 RIDGE AVE
EVANSTON IL
60202-3328
US

IV. Provider business mailing address

355 RIDGE AVE
EVANSTON IL
60202-3328
US

V. Phone/Fax

Practice location:
  • Phone: 847-316-6101
  • Fax:
Mailing address:
  • Phone: 847-316-6101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: