Provider Demographics
NPI:1134238926
Name:CAMPBELL, ANDREW C (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:CAMPBELL
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 1:10604 N. PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:262-242-7772
Mailing Address - Fax:262-478-0884
Practice Address - Street 1:10604 N PORT WASHINTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5013
Practice Address - Country:US
Practice Address - Phone:262-242-7772
Practice Address - Fax:262-478-0884
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39563207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery