Healthcare Provider Details

I. General information

NPI: 1669386397
Provider Name (Legal Business Name): JOINTS & SPORTS CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5059 W 111TH ST
ALSIP IL
60803-6074
US

IV. Provider business mailing address

5059 W 111TH ST
ALSIP IL
60803-6074
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-1300
  • Fax:
Mailing address:
  • Phone: 708-425-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. LUIS PABLO CARRILERO
Title or Position: SOLE OWNER
Credential: MD
Phone: 708-425-1300