Individual
LUIS JACINTO REDONDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10719 160TH ST, ORLAND PARK, IL 60467-5541
(708) 226-3300
(708) 226-4202
Mailing address
75 REMITTANCE DR, SUITE 6581, CHICAGO, IL 60675-1001
(708) 226-3300
(708) 226-4202
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-075192
IL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
036075192
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-075192
BLUE CROSS BLUE SHIELD PROVIDER NUMBER
IL
01
—
200034655
RAILROAD MEDICARE PROVIDER NUMBER
IL
Enumeration date
05/13/2006
Last updated
12/20/2021
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