Provider Demographics
NPI:1447369327
Name:CAMARA, MIGUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:CAMARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0928
Mailing Address - Country:US
Mailing Address - Phone:815-729-9900
Mailing Address - Fax:815-729-9913
Practice Address - Street 1:2228 WEBER RD
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0928
Practice Address - Country:US
Practice Address - Phone:815-729-9900
Practice Address - Fax:815-729-9913
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092279207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG26894Medicare UPIN
IL206080Medicare ID - Type Unspecified