Healthcare Provider Details

I. General information

NPI: 1538419544
Provider Name (Legal Business Name): JOSEPH ESCOBAR ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 KETTERING RD
MUNDELEIN IL
60060-5364
US

IV. Provider business mailing address

1330 KETTERING RD
MUNDELEIN IL
60060-5364
US

V. Phone/Fax

Practice location:
  • Phone: 847-566-2193
  • Fax:
Mailing address:
  • Phone: 847-566-2193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277000440
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209009807
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: