MEDICARE: THOMAS J CAMPBELL MD

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	207R00000X	Internal Medicine Physician	036042217	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	:	1972506665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS J CAMPBELL MD

Provider Business Mailing Address
First Line	:	800 AUSTIN ST
Second Line	:	STE 451E
City	:	EVANSTON
State	:	IL
Zip	:	60202-3455
Country	:	US
Telephone Number	:	847-316-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 AUSTIN ST
Second Line	:	STE 451E
City	:	EVANSTON
State	:	IL
Zip	:	60202-3455
Country	:	US
Telephone Number	:	847-316-6611
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/11/2021

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