Provider Demographics
NPI:1861481020
Name:CAMARA, PEDRO R (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:R
Last Name:CAMARA
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 1:221 W PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3136
Mailing Address - Country:US
Mailing Address - Phone:847-221-4800
Mailing Address - Fax:847-221-4896
Practice Address - Street 1:363 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2414
Practice Address - Country:US
Practice Address - Phone:847-221-4600
Practice Address - Fax:847-221-4696
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC49353Medicare UPIN
ILL22987Medicare PIN