Provider Demographics
NPI:1902961006
Name:CAMPO, ADALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ADALBERTO
Middle Name:
Last Name:CAMPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 N WESTERN AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:773-645-1000
Mailing Address - Fax:773-645-1069
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:773-645-1000
Practice Address - Fax:773-645-1069
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064958207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
110144723OtherRAILROAD MEDICARE
IL036064958Medicaid
31602366OtherBCBS
IL036064958Medicaid
D15413Medicare UPIN