Provider Demographics
NPI:1891257853
Name:MARTINEZ ESCALA, MARIA ESTELA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MARIA ESTELA
Middle Name:
Last Name:MARTINEZ ESCALA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HARVESTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6686
Mailing Address - Country:US
Mailing Address - Phone:773-702-1150
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE STE MC5067
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1443
Practice Address - Country:US
Practice Address - Phone:773-702-0549
Practice Address - Fax:773-834-7071
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.074304207R00000X, 207N00000X
IL036.163235207ZD0900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program