Physician Compare National (NPI:1912992470)

HEALTHCARE PROVIDER: MARK CAMILLERI DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1912992470
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6305731472
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101030000119
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CAMILLERI
	Individual professional last name
Provider First Name	MARK
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1993
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2618 RIDGELAND AVE
	Group Practice or individual's line 1 address
City	BERWYN
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	604025184
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y