Healthcare Provider Details

I. General information

NPI: 1225005382
Provider Name (Legal Business Name): DONALD PAUL KAMM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 W HAY ST
DECATUR IL
62526-6324
US

IV. Provider business mailing address

109 BENTON DR
DECATUR IL
62526-1407
US

V. Phone/Fax

Practice location:
  • Phone: 217-424-2374
  • Fax: 217-424-2383
Mailing address:
  • Phone: 217-875-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: