Provider Demographics
NPI:1174586457
Name:CAMPBELL, MITCHELL J (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:SUITE 900
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:508-584-7525
Practice Address - Fax:502-589-0849
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY28014207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000051983JOtherHUMANA- NORTON LEATHERMAN SPINE CENTER
KY000000049467OtherANTHEM (SPINE INSTITUTE)
KY00533158OtherMEDICARE- NORTON LEATHERMAN SPINE CENTER
KY3728039000OtherPASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER
KY50024963OtherPASSPORT- NORTON LEATHERMAN SPINE CENTER
KY8856267OtherCIGNA- NORTON LEATHERMAN SPINE CENTER
KY64280142Medicaid
KY000000049352OtherANTHEM (UNIVERSITY ORTHOP
KY000000628569OtherANTHEM- NORTON LEATHERMAN SPINE CENTER
KY1054523OtherPASSPORT (SPINE INSTITUTE
KY2432609000OtherPASSPORT ADVANTAGE (UNIVE
KY36123OtherCIGNA (SPINE INSTITUTE)
163722400OtherUS DEPT OF LABOR
KY200027304OtherRAILROAD MEDICARE
KY200103760OtherHEALTHY INDIANA PLAN- COMMUNITY MEDICAL ASSOCIATES
KY2433677000OtherPASSPORT ADVANTAGE (SPINE
KYP00764026OtherRAILROAD MEDICARE- NORTON LEATHERMAN SPINE CENTER
KY1049632OtherPASSPORT (UNIVERSITY ORT
IN200103760AMedicaid
KY667790OtherCIGNA (UNIVERSITY ORTHOPA
KYN293520OtherHARMONY (SPINE INSTITUTE)
IN200103760Medicaid
KY8856267OtherCIGNA- NORTON LEATHERMAN SPINE CENTER
KY200027304OtherRAILROAD MEDICARE
KYN293520OtherHARMONY (SPINE INSTITUTE)
KY667790OtherCIGNA (UNIVERSITY ORTHOPA
KYG08154Medicare UPIN
KY64280142Medicaid