Provider Demographics
NPI:1992739429
Name:KAMP, ROBERT C II (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:KAMP
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SAND POINT RD.
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1406
Mailing Address - Country:US
Mailing Address - Phone:906-387-4110
Mailing Address - Fax:
Practice Address - Street 1:1500 SAND POINT RD.
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1406
Practice Address - Country:US
Practice Address - Phone:920-387-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1137-023363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42989900Medicaid
MI23-8650OtherRHC CERTIFICATION NUMBER
WI970013386OtherMEDICARE RAILROAD
WI970013387OtherMEDICARE RAILROAD
WI970013387OtherMEDICARE RAILROAD
WI970013386OtherMEDICARE RAILROAD
P00281Medicare UPIN
WI0018-40115Medicare ID - Type Unspecified
WI42989900Medicaid