Provider Demographics
NPI:1376702837
Name:MICHAEL L CAMPBELL MD PSC
Entity Type:Organization
Organization Name:MICHAEL L CAMPBELL MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-842-1660
Mailing Address - Street 1:1325 ANDREA ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5852
Mailing Address - Country:US
Mailing Address - Phone:270-842-1660
Mailing Address - Fax:270-843-1911
Practice Address - Street 1:1325 ANDREA ST
Practice Address - Street 2:SUITE 209
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5852
Practice Address - Country:US
Practice Address - Phone:270-842-1660
Practice Address - Fax:270-843-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41068208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY41068OtherKY STATE LICENSE
KY1700924743OtherINDIVIDUAL NPI
KY00650001OtherMEDICARE
KY7100043530Medicaid
KY41068OtherKY STATE LICENSE