Healthcare Provider Details

I. General information

NPI: 1831227818
Provider Name (Legal Business Name): JAIME RICARDO ESCOBAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR STREET SUITE 309
MELROSE PARK IL
60160-4156
US

IV. Provider business mailing address

1111 SUPERIOR STREET SUITE 309
MELROSE PARK IL
60160-4156
US

V. Phone/Fax

Practice location:
  • Phone: 708-343-0420
  • Fax: 708-343-4290
Mailing address:
  • Phone: 708-343-0420
  • Fax: 708-343-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36042797
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: