Provider Demographics
NPI:1477733756
Name:PAUL CAMPBELL DO PC
Entity Type:Organization
Organization Name:PAUL CAMPBELL DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-775-5332
Mailing Address - Street 1:43750 GARFIELD RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1135
Mailing Address - Country:US
Mailing Address - Phone:586-228-4652
Mailing Address - Fax:586-228-4533
Practice Address - Street 1:18303 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4988
Practice Address - Country:US
Practice Address - Phone:586-498-5160
Practice Address - Fax:586-498-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08-5503076-4OtherBCBS PIN
MIE26471Medicare UPIN
MI5503076Medicare PIN
MI0P50100Medicare PIN