Healthcare Provider Details

I. General information

NPI: 1841290491
Provider Name (Legal Business Name): ALAN D CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MICHIGAN ST NE SUITE 3100
GRAND RAPIDS MI
49503-2562
US

IV. Provider business mailing address

5800 FOREMOST DR SE STE 300
GRAND RAPIDS MI
49546-7062
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-9800
  • Fax: 616-954-2116
Mailing address:
  • Phone: 616-954-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number4301043853
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: