Provider Demographics
NPI:1598781056
Name:SALCEDO, FEDERICO N (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:N
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 N INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1224
Mailing Address - Country:US
Mailing Address - Phone:812-246-8193
Mailing Address - Fax:812-246-0825
Practice Address - Street 1:433 N INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1224
Practice Address - Country:US
Practice Address - Phone:812-246-8193
Practice Address - Fax:812-246-0825
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056192207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200395740AMedicaid
IN194400Medicare PIN
IN200395740AMedicaid