Tracy Campbell MD LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036120737 Issued in IL

Legal business name

TRACY CAMPBELL MD LLC

Practice address

675 W North Ave Ste 506
Melrose Park, IL 60160-1626

Phone

(708) 450-5086

Fax

(708) 345-4075

NPI assigned

Sep 13, 2010

Organization subpart

No

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

Authorized official

Name

Tracy Campbell, M.D.NPI 1598921249

Title

Sole Proprietor

Phone

(708) 450-5086

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tracy Marie Allen Campbell, M.D.

  • Dermatology Physician
  • Melrose Park, IL
  • NPI 1598921249
  Medicare reassignment NPD Authorized official
• Julie A Moore, M.D.

  • Dermatology Physician
  • Melrose Park, IL
  • NPI 1053373589
  NPD
• Michaela Rose Reinhart, PA-C

  • Physician Assistant
  • Melrose Park, IL
  • NPI 1710510391
  NPD

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

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299196800000",
    "number": "1710294756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 W NORTH AVE STE 506",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601626",
            "telephone_number": "708-450-5086",
            "fax_number": "708-345-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 W NORTH AVE STE 506",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601626",
            "telephone_number": "708-450-5086",
            "fax_number": "708-345-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY CAMPBELL MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-13",
        "last_updated": "2011-03-04",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "708-450-5086",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036120737",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IL",
            "license": "036120737",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jyothi V Thota, MD
• Tracey Elena Tillis
• Darold S Tolefree, MSW
• Total Foot and Ankle PLLC
• Andrew Robert Townsend, CT
• Steven Vsevolod Trakhtman, PHYSICIAN ASSISTANT
• Alejandra Trimino, LSW
• Yuridia Trujillo, BSW
• Nicole Emily Trytko, DMD
• Latoya D Tucker

• Dermatology Physician in Melrose Park, IL
• Providers in Melrose Park, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.