Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 39563 | WI |
NPI | 1134238926 |
---|---|
Provider Name | Dr. Andrew C Campbell |
First Address | Mequon, WI 53092 |
Second Address | Mequon, WI 53092-5013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 04/12/2013 |