Healthcare Provider Details

I. General information

NPI: 1396208294
Provider Name (Legal Business Name): MICHAEL LUIS REDONDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 95TH ST STE 100
OAK LAWN IL
60453-3072
US

IV. Provider business mailing address

10719 160TH ST
ORLAND PARK IL
60467-5568
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-3300
  • Fax: 708-226-3500
Mailing address:
  • Phone: 708-226-3300
  • Fax: 708-226-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036173917
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number036173917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: