Healthcare Provider Details

I. General information

NPI: 1497740039
Provider Name (Legal Business Name): WILLIAM MICHAEL CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE CHILDREN'S HOSPITAL COLORADO, B140
AURORA CO
80045-7106
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-6632
  • Fax: 720-777-7311
Mailing address:
  • Phone: 303-493-7000
  • Fax: 303-493-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30494
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number30494
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: