Healthcare Provider Details

I. General information

NPI: 1154203743
Provider Name (Legal Business Name): JON ESCAMILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W ALGONQUIN RD
LAKE IN THE HILLS IL
60156-3500
US

IV. Provider business mailing address

1371 GLACIER PKWY
ALGONQUIN IL
60102-5416
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-8233
  • Fax: 847-658-8233
Mailing address:
  • Phone: 847-354-1103
  • Fax: 847-354-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number000827030
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: