MEDICARE: DR. DOUGLAS G CAMPBELL M.D.

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	207R00000X	Internal Medicine Physician	4301041491	MI

General Provider Information

NPI Number	:	1225028921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS G CAMPBELL M.D.

Provider Business Mailing Address
First Line	:	1717 SHAFFER ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1647
Country	:	US
Telephone Number	:	269-226-5967
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 SHAFFER ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1647
Country	:	US
Telephone Number	:	269-226-5967
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	02/05/2019

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