Healthcare Provider Details

I. General information

NPI: 1275944266
Provider Name (Legal Business Name): THOMAS CAMPBELL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 KIRCHOFF RD STE 104
ROLLING MEADOWS IL
60008-2005
US

IV. Provider business mailing address

16 N YALE AVE
VILLA PARK IL
60181-2339
US

V. Phone/Fax

Practice location:
  • Phone: 312-202-6837
  • Fax:
Mailing address:
  • Phone: 847-445-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016.005662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: