Provider Demographics
NPI:1750456026
Name:CAMPBELL, DAVID ALEXANDER (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51110 BRENSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9267
Mailing Address - Country:US
Mailing Address - Phone:574-271-9616
Mailing Address - Fax:
Practice Address - Street 1:209 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8048
Practice Address - Country:US
Practice Address - Phone:574-246-1000
Practice Address - Fax:574-246-4000
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035158A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000176320OtherANTHEM
IN100204030BMedicaid
INAC1762079OtherDEA NUMBER
IN000000176320OtherANTHEM
IN167200Medicare ID - Type Unspecified
INE11171Medicare UPIN