MEDICARE: SALLY ANN CAMPBELL-LEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	036117084	IL
2	207ZB0001X	Blood Banking & Transfusion Medicine Physician	036117084	IL
3	207ZC0006X	Clinical Pathology Physician	036-117084	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669430773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY ANN CAMPBELL-LEE M.D.

Provider Business Mailing Address
First Line	:	840 S WOOD ST
Second Line	:	MC 847 ROOM 130 CSN UIC DEPT OF PATHOLOGY
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-996-1350
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 W TAYLOR ST
Second Line	:	UNIVERSITY OF ILLINOIS AT CHICAGO HOSPITAL ROOM 3138
City	:	CHICAGO
State	:	IL
Zip	:	60612-7232
Country	:	US
Telephone Number	:	312-996-1350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/14/2020

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