Healthcare Provider Details

I. General information

NPI: 1124403563
Provider Name (Legal Business Name): JAMES REDDING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N RANDALL RD
ELGIN IL
60123-2300
US

IV. Provider business mailing address

1425 N RANDALL RD
ELGIN IL
60123-2300
US

V. Phone/Fax

Practice location:
  • Phone: 224-783-2932
  • Fax: 224-783-2032
Mailing address:
  • Phone: 224-783-2932
  • Fax: 224-783-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209012929
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: