MEDICARE: DR. ALEXANDER ADAM ESCHBACH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist		IL
2	103TC0700X	Clinical Psychologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1622330	OTHER	IL	BLUE CROSS / BLUE SHIELD

General Provider Information

NPI Number	:	1417940610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER ADAM ESCHBACH PH.D.

Provider Business Mailing Address
First Line	:	800 E. WOODFIELD ROAD
Second Line	:	SUITE 610
City	:	SCHAUMBURG
State	:	IL
Zip	:	60173
Country	:	US
Telephone Number	:	847-240-0444
Fax Number	:	847-240-0446

Provider Business Practice Location Address
First Line	:	1000 GRAND CANYON PKWY
Second Line	:	SUITE 203
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60194-1705
Country	:	US
Telephone Number	:	847-755-0555
Fax Number	:	847-755-0580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/10/2007

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Directions to “ DR. ALEXANDER ADAM ESCHBACH PH.D.” Practice Location

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