Provider Demographics
NPI:1942886643
Name:CAMPBELL, MARGARET ROSE (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ROSE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:ROSE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3000
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3000
Practice Address - Fax:816-302-9939
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-10565208000000X
MO2021018689208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200096229Medicaid
MO2021018689OtherMISSOURI BOARD OF HEALING ARTS - MISSOURI TEMPORARY LICENSE
KS94-10565OtherKANSAS STATE BOARD OF HEALING ARTS MEDICAL DOCTOR POSTGRAD PERMIT (MD)