Provider Demographics
NPI:1982690632
Name:ESPINOSA, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19680
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9680
Mailing Address - Country:US
Mailing Address - Phone:217-545-5878
Mailing Address - Fax:217-545-8103
Practice Address - Street 1:421 N 9TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5317
Practice Address - Country:US
Practice Address - Phone:217-545-5878
Practice Address - Fax:217-545-8103
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089047207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089047Medicaid
ILL60174Medicare ID - Type Unspecified
IL036089047Medicaid