Healthcare Provider Details

I. General information

NPI: 1861615148
Provider Name (Legal Business Name): ASSOCIATES IN PRIMARY CARE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 RIDGE AVE SUITE 109
EVANSTON IL
60201-2455
US

IV. Provider business mailing address

2500 RIDGE AVE SUITE 109
EVANSTON IL
60201-2455
US

V. Phone/Fax

Practice location:
  • Phone: 847-328-4343
  • Fax:
Mailing address:
  • Phone: 847-328-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. WALTER D CAMPBELL
Title or Position: PHYSICIAN
Credential: MD
Phone: 847-328-4343