Provider Demographics
NPI:1558750372
Name:CAMACHO MURILLO, MARIO ANDRES (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ANDRES
Last Name:CAMACHO MURILLO
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 1:734 N THROOP ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5740
Mailing Address - Country:US
Mailing Address - Phone:857-928-1865
Mailing Address - Fax:
Practice Address - Street 1:DH DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - Street 2:777 BANNOCK ST MC 0108
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:857-928-1865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0067760207P00000X
IL036148893207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine