Provider Demographics
NPI:1245457282
Name:COLADA, ANDREA OCAMPO (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:OCAMPO
Last Name:COLADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ARBURY CT.
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-346-5315
Mailing Address - Fax:
Practice Address - Street 1:1323 MEMORIAL DRIVE, STE 214
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-245-8900
Practice Address - Fax:708-245-5604
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine