Provider Demographics
NPI:1528230133
Name:CAMPBELL, ELIZABETH KRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KRISTINE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 GLENDALE BLVD
Mailing Address - Street 2:STE. 101
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3767
Mailing Address - Country:US
Mailing Address - Phone:219-462-0555
Mailing Address - Fax:
Practice Address - Street 1:1101 GLENDALE BLVD
Practice Address - Street 2:STE. 101
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3767
Practice Address - Country:US
Practice Address - Phone:219-462-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6348767-1205208000000X
IN01065148A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics