Healthcare Provider Details

I. General information

NPI: 1609868819
Provider Name (Legal Business Name): JOSE M PAREDES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17333 LA GRANGE RD STE 200
TINLEY PARK IL
60487-7510
US

IV. Provider business mailing address

17901 GOVERNORS HWY STE 208
HOMEWOOD IL
60430-1146
US

V. Phone/Fax

Practice location:
  • Phone: 708-342-1900
  • Fax: 708-745-9993
Mailing address:
  • Phone: 708-957-2100
  • Fax: 708-745-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036064180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: