Healthcare Provider Details

I. General information

NPI: 1295958569
Provider Name (Legal Business Name): WALTER D CAMPBELL MD LLC
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

2401 RAVINE WAY SUITE 101
GLENVIEW IL
60025-7645
US

IV. Provider business mailing address

2401 RAVINE WAY SUITE 101
GLENVIEW IL
60025-7645
US

V. Phone/Fax

Practice location:
  • Phone: 847-724-1940
  • Fax: 847-724-1985
Mailing address:
  • Phone: 847-724-1940
  • Fax: 847-724-1985

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: 847-724-1940