Healthcare Provider Details

I. General information

NPI: 1053396135
Provider Name (Legal Business Name): LUIS FERNANDO ESCOBAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 HARCOURT RD STE 300
INDIANAPOLIS IN
46260-2052
US

IV. Provider business mailing address

8402 HARCOURT RD STE 300
INDIANAPOLIS IN
46260-2052
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-5288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01044143A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01044143A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01044143A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number01044143A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: