Provider Demographics
NPI:1265613962
Name:JAIME R ESCOBAR, MD,LTD
Entity type:Organization
Organization Name:JAIME R ESCOBAR, MD,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:R
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-343-0420
Mailing Address - Street 1:1111 SUPERIOR ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4138
Mailing Address - Country:US
Mailing Address - Phone:708-343-0420
Mailing Address - Fax:708-343-4290
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 309
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-343-0420
Practice Address - Fax:708-343-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41679Medicare UPIN
466321Medicare PIN