Provider Demographics
NPI:1205863370
Name:KAMBOL, JAMES J (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:KAMBOL
Suffix:
Gender:M
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:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:414-290-6755
Practice Address - Street 1:1032 E SUMNER ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-1608
Practice Address - Country:US
Practice Address - Phone:262-673-2300
Practice Address - Fax:262-670-7620
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097283207P00000X
WI33079-020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31913200Medicaid
WI930053854OtherMEDICARE RAILROAD
WI930045953OtherMEDICARE RAILROAD
WI930081051OtherMEDICARE RAILROAD
E64671Medicare UPIN
WI0007-32280Medicare ID - Type Unspecified
WI0038-01400Medicare ID - Type Unspecified
WI930053854OtherMEDICARE RAILROAD
WI0035-68655Medicare ID - Type Unspecified