Healthcare Provider Details

I. General information

NPI: 1669430773
Provider Name (Legal Business Name): SALLY ANN CAMPBELL-LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST UNIVERSITY OF ILLINOIS AT CHICAGO HOSPITAL ROOM 3138
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

840 S WOOD ST MC 847 ROOM 130 CSN UIC DEPT OF PATHOLOGY
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-1350
  • Fax:
Mailing address:
  • Phone: 312-996-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number036117084
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number036117084
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number036-117084
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: