Healthcare Provider Details

I. General information

NPI: 1215040654
Provider Name (Legal Business Name): MAIBRITT CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE DEPARTMENT OF DIAGNOSTIC RADIOLOGY
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

836 W WELLINGTON AVE DEPARTMENT OF DIAGNOSTIC RADIOLOGY
CHICAGO IL
60657-5147
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7820
  • Fax: 773-296-7821
Mailing address:
  • Phone: 773-296-7820
  • Fax: 773-296-7821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36118737
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: