Healthcare Provider Details

I. General information

NPI: 1306436787
Provider Name (Legal Business Name): ADAM L ESCOBEDO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 GARFIELD AVE STE 206
LIBERTYVILLE IL
60048-3100
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-816-7495
  • Fax: 847-816-7497
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022694
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: