Individual
MATTHEW CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2300 WESTERN AVE, MANITOWOC, WI 54220-3712
(920) 320-3165
Mailing address
PO BOX 2290, MANITOWOC, WI 54221-2290
(920) 320-2591
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
51519
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821030859
BCBS
WI
05
—
208600000X
—
WI
01
—
P00688641
RR MEDICARE
WI
Enumeration date
06/12/2006
Last updated
02/01/2012
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