MEDICARE: DR. TIFFANY MICHELLE CAMPOS

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	163WC0400X	Case Management Registered Nurse	041467673	IL

General Provider Information

NPI Number	:	1952257289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY MICHELLE CAMPOS

Provider Business Mailing Address
First Line	:	1713 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2014
Country	:	US
Telephone Number	:	312-742-1948
Fax Number	:

Provider Business Practice Location Address
First Line	:	1713 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2014
Country	:	US
Telephone Number	:	312-742-1978
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/19/2026

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Directions to “ DR. TIFFANY MICHELLE CAMPOS ” Practice Location

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