Individual
FERNANDO S. ESCOVAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2120 RIETH BLVD STE C, GOSHEN, IN 46526-5858
(574) 875-6911
(574) 875-1057
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01044055A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000851184
BCBS BMG GOSHEN
IN
05
—
200041830
—
IN
Enumeration date
07/15/2005
Last updated
04/01/2021
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