Healthcare Provider Details

I. General information

NPI: 1760942684
Provider Name (Legal Business Name): GIOVANNI ANTONIO CAMPAGNA II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 04/25/2024
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE DEPT OPHTHALMOLOGY, 6TH FL
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3937
  • Fax: 866-505-8818
Mailing address:
  • Phone: 314-362-3937
  • Fax: 866-505-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number2023004662
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: