Provider Demographics
NPI:1932291580
Name:CAMPBELL, JEANETTE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:M
Last Name:CAMPBELL
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 1:44656 WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5027
Mailing Address - Country:US
Mailing Address - Phone:248-335-6282
Mailing Address - Fax:
Practice Address - Street 1:44656 WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5027
Practice Address - Country:US
Practice Address - Phone:248-335-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040529208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAC8576437OtherDEA #
MIA74590Medicare UPIN