Provider Demographics
NPI:1225005382
Name:KAMM, DONALD PAUL (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:PAUL
Last Name:KAMM
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 1:109 BENTON DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1407
Mailing Address - Country:US
Mailing Address - Phone:217-875-1720
Mailing Address - Fax:
Practice Address - Street 1:441 W HAY ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6324
Practice Address - Country:US
Practice Address - Phone:217-424-2374
Practice Address - Fax:217-424-2383
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL007358OtherHEALTH ALLIANCE
IL107867OtherHEALTHLINK
IL0005800238OtherBLUE CROSS/BLUE SHIELD
IL107867OtherHEALTHLINK
D14030Medicare UPIN