Healthcare Provider Details

I. General information

NPI: 1740817774
Provider Name (Legal Business Name): DMITRIY PERESADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10719 160TH ST
ORLAND PARK IL
60467-5568
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: 312-217-5806
  • Fax: 708-226-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number036178484
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: