Healthcare Provider Details

I. General information

NPI: 1821656661
Provider Name (Legal Business Name): JUSTIN PATRICK CAMPAGNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14044 W CAMELBACK RD STE 118
LITCHFIELD PARK AZ
85340-9481
US

IV. Provider business mailing address

14044 W CAMELBACK RD STE 118
LITCHFIELD PARK AZ
85340-9481
US

V. Phone/Fax

Practice location:
  • Phone: 623-547-2600
  • Fax: 623-547-1899
Mailing address:
  • Phone: 623-547-2600
  • Fax: 623-547-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberR77259
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number61692
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: