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NPI Code Detail

MEDICARE: MR. BRYAN JOSEPH OCAMPO PA-S

MEDICARE: MR. BRYAN JOSEPH OCAMPO PA-S
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
1363AM0700XMedical Physician Assistant085.010471IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1881315463
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRYAN JOSEPH OCAMPO PA-S
Provider Business Mailing Address
First Line : 1645 W SCHOOL ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-2157
Country : US
Telephone Number : 773-227-3669
Fax Number :
Provider Business Practice Location Address
First Line : 1645 W SCHOOL ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-2157
Country : US
Telephone Number : 773-227-3669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2022
Last Update Date : 03/11/2025

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