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General NPI Number Information
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NPI Number | 1245457282
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Entity Type | Individual
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Provider Name | ANDREA OCAMPO COLADA M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 1323 MEMORIAL DRIVE, STE 214
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City | LA GRANGE
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State | IL
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Zip | 60525
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Country | US
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Telephone | 708-245-8900
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Fax | 708-245-5604
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Provider Business Mailing Address
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Address Line | 2 ARBURY CT.
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City | BOLINGBROOK
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State | IL
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Zip | 60440
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Country | US
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Telephone | 630-346-5315
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036117210
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License Number State | IL
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