Provider Demographics
NPI:1649477688
Name:ADALBERTO CAMPO MD SC
Entity type:Organization
Organization Name:ADALBERTO CAMPO MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD SC
Authorized Official - Phone:773-645-1000
Mailing Address - Street 1:1431 N WESTERN AVE
Mailing Address - Street 2:#506
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:773-645-1000
Mailing Address - Fax:773-645-1069
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:#506
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:773-645-1000
Practice Address - Fax:773-645-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064958207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064958Medicaid
31602366OtherBLUE CROSS BLUE SHIELD IL
724750Medicare ID - Type Unspecified