Provider Demographics
NPI:1255744488
Name:CAMPORESE, MICHAEL (APN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CAMPORESE
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 REMINGTON RD SUITE X
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:FL
Mailing Address - Zip Code:60173
Mailing Address - Country:US
Mailing Address - Phone:630-237-4500
Mailing Address - Fax:
Practice Address - Street 1:1325 REMINGTON RD STE X
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4815
Practice Address - Country:US
Practice Address - Phone:630-237-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily