Provider Demographics
NPI:1184637795
Name:CAMPBELL, SARAH C (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:C
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 S. ONEIDA STREET
Mailing Address - Street 2:PEDIATRICS
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1569
Mailing Address - Country:US
Mailing Address - Phone:920-730-4950
Mailing Address - Fax:
Practice Address - Street 1:1506 S. ONEIDA STREET
Practice Address - Street 2:PEDIATRICS
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1569
Practice Address - Country:US
Practice Address - Phone:920-730-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45366208000000X
MI4301083413208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35388600Medicaid
MI0829560001OtherMEDICARE DME
MISC083413OtherBLUE CROSS STATE ID
0C16002OtherMEDICARE GROUP
MI104654657Medicaid
MISC083413OtherBLUE CROSS STATE ID
I16511Medicare UPIN