Provider Demographics
NPI:1083860522
Name:DR. WILLIAM CAMPBELL, LTD.
Entity Type:Organization
Organization Name:DR. WILLIAM CAMPBELL, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-736-1555
Mailing Address - Street 1:4403 W LAWRENCE AVE
Mailing Address - Street 2:SUITE : 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2513
Mailing Address - Country:US
Mailing Address - Phone:773-736-1555
Mailing Address - Fax:773-736-1552
Practice Address - Street 1:4403 W LAWRENCE AVE
Practice Address - Street 2:SUITE : 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2513
Practice Address - Country:US
Practice Address - Phone:773-736-1555
Practice Address - Fax:773-736-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119743Medicaid
ILFC0619328OtherDEA