Provider Demographics
NPI:1306856190
Name:CAMPBELL, ABRAHAM L (DO)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829
Mailing Address - Country:US
Mailing Address - Phone:906-786-7471
Mailing Address - Fax:906-786-5562
Practice Address - Street 1:2525 5TH AVE S
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829
Practice Address - Country:US
Practice Address - Phone:906-786-7471
Practice Address - Fax:906-786-5562
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014306208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4627328Medicaid
MIAC014306OtherBCBS
MIP00146426OtherRR MEDICARE
MI4627328Medicaid