Provider Demographics
NPI:1194254243
Name:CAMPBELL, RACHEL GRIMMER (DO)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:GRIMMER
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 1:233 S GARY AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2213
Mailing Address - Country:US
Mailing Address - Phone:630-924-4009
Mailing Address - Fax:630-924-9671
Practice Address - Street 1:233 S GARY AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2213
Practice Address - Country:US
Practice Address - Phone:630-924-4009
Practice Address - Fax:630-924-9671
Is Sole Proprietor?:No
Enumeration Date:2017-06-11
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005929A207Q00000X
IL036161624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN224040141OtherMEDICARE
ININ4866006OtherMEDICARE
IN300039587Medicaid