Healthcare Provider Details

I. General information

NPI: 1346581113
Provider Name (Legal Business Name): FRED JENDO C.S.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 E RAND RD STE 7
MOUNT PROSPECT IL
60056-2560
US

IV. Provider business mailing address

PO BOX 217
GLENVIEW IL
60025-0217
US

V. Phone/Fax

Practice location:
  • Phone: 773-401-6715
  • Fax:
Mailing address:
  • Phone: 773-401-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238000359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: