Provider Demographics
NPI:1154203743
Name:ESCAMILLA, JON
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:ESCAMILLA
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 1:1371 GLACIER PKWY
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5416
Mailing Address - Country:US
Mailing Address - Phone:847-354-1103
Mailing Address - Fax:847-354-1103
Practice Address - Street 1:1020 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-3500
Practice Address - Country:US
Practice Address - Phone:847-658-8233
Practice Address - Fax:847-658-8233
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000827030207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services