MEDICARE: MR. ACEL BLAKE CAMFIELD PA

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	363A00000X	Physician Assistant	2025045740	MO

General Provider Information

NPI Number	:	1982215471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ACEL BLAKE CAMFIELD PA

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	314-514-3500
Fax Number	:	314-878-7678

Provider Business Practice Location Address
First Line	:	20 PROGRESS POINT PKWY
Second Line	:	DEPT ORTHOPAEDIC SURGERY, STE 114
City	:	O FALLON
State	:	MO
Zip	:	63368-2206
Country	:	US
Telephone Number	:	314-514-3500
Fax Number	:	314-878-7678

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

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	01/14/2026

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