Provider Demographics
NPI:1174501159
Name:OCAMPO, ENRICO (MD, FACP, FACE)
Entity Type:Individual
Prefix:DR
First Name:ENRICO
Middle Name:
Last Name:OCAMPO
Suffix:
Gender:M
Credentials:MD, FACP, FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:MN
Mailing Address - Zip Code:56178-1166
Mailing Address - Country:US
Mailing Address - Phone:507-247-5921
Mailing Address - Fax:507-247-5184
Practice Address - Street 1:240 WILLOW ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:MN
Practice Address - Zip Code:56178-1166
Practice Address - Country:US
Practice Address - Phone:507-247-5921
Practice Address - Fax:507-247-5184
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219031207RE0101X
MN38557207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4C0736OtherPHCS
NY28P0352OtherNY PRESBYTERIAN
NY166149OtherELDERPLAN
NYP2137433OtherOXFORD
NY133442196OtherUNITED HEALTHCARE
NY133442196OtherMAGNACARE
NY133442196Other1199 NATIONAL BENEFIT
NY6235251004OtherCIGNA
NYEO08607710OtherEMPIRE B/C B/S
NY133442196OtherMAGNACARE