Provider Demographics
NPI:1124075684
Name:CAMPBELL, CHRISTINA L (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4572 OAKHURST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-5071
Mailing Address - Country:US
Mailing Address - Phone:248-425-8352
Mailing Address - Fax:
Practice Address - Street 1:6310 SASHABAW RD STE A
Practice Address - Street 2:CHRISTINA CAMPBELL, DO, PLLC
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2270
Practice Address - Country:US
Practice Address - Phone:248-425-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014451207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH27112Medicare UPIN
MIN57910017Medicare ID - Type Unspecified