Provider Demographics
NPI:1558437269
Name:CAMPOS, HELAR EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:HELAR
Middle Name:EDGAR
Last Name:CAMPOS
Suffix:
Gender:M
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:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-1466
Mailing Address - Country:US
Mailing Address - Phone:262-788-9229
Mailing Address - Fax:262-788-9241
Practice Address - Street 1:435 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4621
Practice Address - Country:US
Practice Address - Phone:860-444-7400
Practice Address - Fax:860-444-7401
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001403419Medicaid
CTH76434Medicare UPIN
CT001403419Medicaid