Healthcare Provider Details

I. General information

NPI: 1588292460
Provider Name (Legal Business Name): LAURA ESRY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LAURA COLBOCH

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DEMPSTER ST
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-6522
  • Fax: 847-696-3394
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036-181260
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: