Healthcare Provider Details

I. General information

NPI: 1598853608
Provider Name (Legal Business Name): JOHN N CAMPBELL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 VIEWPOND DRIVE SE SUITE 100A
KENTWOOD MI
49508
US

IV. Provider business mailing address

1676 VIEWPOND DRIVE SE SUITE 100A
KENTWOOD MI
49508
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-9450
  • Fax: 616-455-5221
Mailing address:
  • Phone: 616-455-9450
  • Fax: 616-455-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN NELSON CAMPBELL
Title or Position: PRESIDENT
Credential: MD
Phone: 616-455-9450