Provider Demographics
NPI:1851413215
Name:REDONDO, ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
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 1:23 SHEFFIELD LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2353
Mailing Address - Country:US
Mailing Address - Phone:630-572-8217
Mailing Address - Fax:
Practice Address - Street 1:2737 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3509
Practice Address - Country:US
Practice Address - Phone:773-376-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice