Provider Demographics
NPI:1811972334
Name:CAMPBELL, WILLIAM BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BERNARD
Last Name:CAMPBELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1717 SHAFFER ST
Mailing Address - Street 2:SUITE 232
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1647
Mailing Address - Country:US
Mailing Address - Phone:269-226-5050
Mailing Address - Fax:269-226-5034
Practice Address - Street 1:1717 SHAFFER ST
Practice Address - Street 2:SUITE 232
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1647
Practice Address - Country:US
Practice Address - Phone:269-226-5050
Practice Address - Fax:269-226-5034
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2011-12-22
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Provider Licenses
StateLicense IDTaxonomies
MI4301041130207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3190203Medicaid
MIA75127Medicare UPIN