Camille Arianne Fonseca, MD,MPH

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036168628 Issued in IL

Practice address

5841 S Maryland Ave # Mc1052
Chicago, IL 60637-1443

Phone

(773) 702-6760

NPI assigned

Jul 18, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1447736814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 HARVESTER DR STE 300",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605275965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE # MC1052",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "773-702-6760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1364 Clifton Rd NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303221059",
            "country_code": "US",
            "telephone_number": "404-712-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONSECA",
        "first_name": "CAMILLE",
        "middle_name": "ARIANNE",
        "credential": "MD,MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-18",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036168628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michal Fonfa, SLP
• Robert Fong II, MD, PHD
• Roger Fong, MPT
• Verissa Lam Fong, O.D.
• Vicki K Fong, RPH
• Luvianca J. Fonseca, M.D.
• Anika Fonson
• Daniel Arthur Fontaine, L.C.P.C
• Alexandra Fontana
• Amerson Fontana

• Pediatrics Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.