Provider Demographics
NPI:1922237023
Name:KAMPMAN, BRIDGET A (MD)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:A
Last Name:KAMPMAN
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 1:201 E MORRISSEY DR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4395
Mailing Address - Country:US
Mailing Address - Phone:262-723-3100
Mailing Address - Fax:
Practice Address - Street 1:201 E MORRISSEY DR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4395
Practice Address - Country:US
Practice Address - Phone:262-723-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-129203207Q00000X
WI71232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100093305Medicaid
IL036129203Medicaid
IL390362Medicare PIN
IL0727500007Medicare NSC