=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609868819
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE M PAREDES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2005
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17333 LA GRANGE RD STE 200
-----------------------------------------------------
City | TINLEY PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60487-7510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-342-1900
-----------------------------------------------------
Fax | 708-745-9993
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17901 GOVERNORS HWY STE 208
-----------------------------------------------------
City | HOMEWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60430-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-957-2100
-----------------------------------------------------
Fax | 708-745-9993
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 036064180
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------