Provider Demographics
NPI:1528383361
Name:ESCOBAR, JEIRY A
Entity Type:Individual
Prefix:
First Name:JEIRY
Middle Name:A
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 N SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5423
Mailing Address - Country:US
Mailing Address - Phone:773-329-6877
Mailing Address - Fax:
Practice Address - Street 1:4425 N SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5423
Practice Address - Country:US
Practice Address - Phone:773-329-6877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILE21642183032171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter