Healthcare Provider Details

I. General information

NPI: 1497343453
Provider Name (Legal Business Name): DAVID MARTIN ESTERQUEST JR. MS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 330
PARK RIDGE IL
60068-1127
US

IV. Provider business mailing address

820 S WOOD ST RM 367
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 847-655-8530
  • Fax:
Mailing address:
  • Phone: 312-996-6765
  • Fax: 312-355-3722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125.078511
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: