Provider Demographics
NPI:1043284367
Name:CAMPBELL, MATTHEW J (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MOMANY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2178
Mailing Address - Country:US
Mailing Address - Phone:269-928-1947
Mailing Address - Fax:269-982-1950
Practice Address - Street 1:405 MOMANY DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2178
Practice Address - Country:US
Practice Address - Phone:269-928-1947
Practice Address - Fax:269-982-1950
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI444169410Medicaid
080191091OtherRAIL ROAD MEDICARE
MIBC7900764OtherDEA
080191091OtherRAIL ROAD MEDICARE
MI444169410Medicaid