Provider Demographics
NPI:1336130723
Name:O'CAMPO, MANUELA B (MD)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:B
Last Name:O'CAMPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:43800 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1136
Mailing Address - Country:US
Mailing Address - Phone:800-848-0202
Mailing Address - Fax:586-226-6949
Practice Address - Street 1:21000 E 12 MILE RD
Practice Address - Street 2:102
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1116
Practice Address - Country:US
Practice Address - Phone:810-447-5700
Practice Address - Fax:810-447-5010
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301035008207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2820033Medicaid
MI2820033Medicaid
A74022Medicare UPIN