Healthcare Provider Details

I. General information

NPI: 1043081227
Provider Name (Legal Business Name): SAMANTHA PAYTON CAMERON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10350 HALIGUS RD STE 220
HUNTLEY IL
60142-9585
US

IV. Provider business mailing address

200 ROSEHALL DR UNIT 250
LAKE ZURICH IL
60047-6266
US

V. Phone/Fax

Practice location:
  • Phone: 847-802-7230
  • Fax:
Mailing address:
  • Phone: 224-358-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: