Basic Information
| Provider Information | |||||||||
| NPI: | 1649684333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPOS | ||||||||
| FirstName: | ABRAHAM | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 JACKSON STREET M.S. 13801B | ||||||||
| Address2: | REGIONS HOSPITAL - EMERGENCY MEDICAL SERVICES | ||||||||
| City: | ST. PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55101 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 265 GRIFFIN ST E | ||||||||
| Address2: | |||||||||
| City: | AMERY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152688000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 7227 | NE | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 62307 | MN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 67342-20 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.