Healthcare Provider Details

I. General information

NPI: 1023083136
Provider Name (Legal Business Name): KAREN CAMPBELL SPACCARELLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 W BRYN MAWR AVE STE 300
CHICAGO IL
60631-3436
US

IV. Provider business mailing address

PO BOX 443
BEDFORD PARK IL
60499-0443
US

V. Phone/Fax

Practice location:
  • Phone: 708-831-8282
  • Fax: 773-714-1229
Mailing address:
  • Phone: 708-831-8282
  • Fax: 773-714-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036088567
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: