Healthcare Provider Details

I. General information

NPI: 1245626001
Provider Name (Legal Business Name): CHELSEA CAMPBELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR SUITE 1000
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 NORTH LAKE SHORE DRIVE SUITE 1000
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0665
  • Fax:
Mailing address:
  • Phone: 312-695-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.005885
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.005885
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: