Provider Demographics
NPI:1770692030
Name:REDA, MATTHEW KEVIN (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KEVIN
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 1:1000 N WESTMORELAND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1658
Mailing Address - Country:US
Mailing Address - Phone:847-234-5600
Mailing Address - Fax:847-535-7884
Practice Address - Street 1:1000 N WESTMORELAND RD STE 300
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:847-234-5600
Practice Address - Fax:847-535-7884
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35199207L00000X
IL036161509207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ136789Medicaid
P00769837OtherMEDICARE RAILROAD
P00769837OtherMEDICARE RAILROAD