Healthcare Provider Details

I. General information

NPI: 1659405231
Provider Name (Legal Business Name): COLIN FRECCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N HALSTED ST STE 506
CHICAGO IL
60642-2615
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 773-883-0274
  • Fax: 773-883-0208
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036.123067
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: