Healthcare Provider Details

I. General information

NPI: 1164595310
Provider Name (Legal Business Name): MIECHIA ASHAWN ESCO M.D.,PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W CLAIREMONT AVE
EAU CLAIRE WI
54701-6122
US

IV. Provider business mailing address

3810 NORTHDALE BLVD STE 150
TAMPA FL
33624-1871
US

V. Phone/Fax

Practice location:
  • Phone: 715-717-4121
  • Fax:
Mailing address:
  • Phone: 228-376-0425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number230433
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number4301095536
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2015-00576
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME120203
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2015-00576
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: