Provider Demographics
NPI:1467498618
Name:REDA, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:REDA
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 1:11 SALT CREEK LN STE 125
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3041
Mailing Address - Country:US
Mailing Address - Phone:630-655-1177
Mailing Address - Fax:
Practice Address - Street 1:11 SALT CREEK LN STE 125
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3041
Practice Address - Country:US
Practice Address - Phone:630-655-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-065328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065328-1Medicaid
IL080021805OtherMEDICARE RAILROAD
IL1617057OtherBLUE CROSS BLUE SHIELD
IL080021805OtherMEDICARE RAILROAD
P07332Medicare PIN