Provider Demographics
NPI:1275763708
Name:COLLADO, FAREED MOSES SEGUNDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FAREED MOSES
Middle Name:SEGUNDO
Last Name:COLLADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 1159
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3883
Mailing Address - Country:US
Mailing Address - Phone:312-942-5020
Mailing Address - Fax:312-942-4039
Practice Address - Street 1:1725 W HARRISON ST STE 1159
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3883
Practice Address - Country:US
Practice Address - Phone:312-942-5020
Practice Address - Fax:312-942-4039
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-129886207RA0002X, 207RI0011X
ORMD187346207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease