Individual
EDWIN W. MCCAMMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1243
(217) 366-6106
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-8107
(217) 366-6106
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085-000055
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
434110
MEDICARE GROUP
—
01
—
P00328875
RAILROAD MEDICARE
—
Enumeration date
08/02/2006
Last updated
03/05/2015
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