Healthcare Provider Details

I. General information

NPI: 1174501159
Provider Name (Legal Business Name): ENRICO OCAMPO M.D., FACP, FACE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLOW ST
TYLER MN
56178-1166
US

IV. Provider business mailing address

240 WILLOW ST
TYLER MN
56178-1166
US

V. Phone/Fax

Practice location:
  • Phone: 507-247-5921
  • Fax: 507-247-5184
Mailing address:
  • Phone: 507-247-5921
  • Fax: 507-247-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number219031
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number38557
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: