MEDICARE: JUAN CAMPBELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036-109131	IL

General Provider Information

NPI Number	:	1205940582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CAMPBELL MD

Provider Business Mailing Address
First Line	:	2720 W 15TH ST
Second Line	:	1ST FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60608-1610
Country	:	US
Telephone Number	:	773-257-1700
Fax Number	:	773-257-6888

Provider Business Practice Location Address
First Line	:	2720 W 15TH ST
Second Line	:	1ST FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60608-1610
Country	:	US
Telephone Number	:	773-257-1700
Fax Number	:	773-257-6888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	05/06/2012

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Directions to “ JUAN CAMPBELL MD” Practice Location

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