Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 034105 | MI |
Y | 111NI0900X | Internist | 034105 | MI |
N | 207RA0401X | Internist - Addiction Medicine | 4301034105 | MI |
NPI | 1417901232 |
---|---|
Provider Name | John N Campbell |
First Address | Kentwood, MI 49508-4994 |
Second Address | Kentwood, MI 49508-4994 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1076881 | (05) | MI |
1598853608 | GROUP NPI (01) | |
382161547 | TAX ID (01) | MI |
B45563 | (02) | MI |