Provider Demographics
NPI:1104163492
Name:EMBRESCIA, JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:EMBRESCIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 CHICAGO AVE
Mailing Address - Street 2:808
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2391
Mailing Address - Country:US
Mailing Address - Phone:847-733-7114
Mailing Address - Fax:
Practice Address - Street 1:811 CHICAGO AVE
Practice Address - Street 2:808
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2391
Practice Address - Country:US
Practice Address - Phone:847-733-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004387207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology