Provider Demographics
NPI:1770544835
Name:CAMPBELL, JEROME THOMAS II (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:THOMAS
Last Name:CAMPBELL
Suffix:II
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:410 NORTH GREEN BAY ROAD
Mailing Address - Street 2:APARTMENT #1015
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-336-4228
Mailing Address - Fax:
Practice Address - Street 1:3420 ILLINOIS STREET
Practice Address - Street 2:USS TRANQUILLITY MEDICAL CLINIC
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-5230
Practice Address - Country:US
Practice Address - Phone:847-680-6175
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical