Provider Demographics
NPI:1710938873
Name:REDONDO, LUIS JACINTO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:JACINTO
Last Name:REDONDO
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 1:75 REMITTANCE DR
Mailing Address - Street 2:SUITE 6581
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1001
Mailing Address - Country:US
Mailing Address - Phone:708-226-3300
Mailing Address - Fax:708-226-4202
Practice Address - Street 1:10719 160TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5541
Practice Address - Country:US
Practice Address - Phone:708-226-3300
Practice Address - Fax:708-226-4202
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075192207XX0005X
IL036-075192207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-075192OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
IL200034655OtherRAILROAD MEDICARE PROVIDER NUMBER
ILE87210Medicare UPIN
IL1032380001Medicare NSC