Basic Information
| Provider Information | |||||||||
| NPI: | 1174501159 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OCAMPO | ||||||||
| FirstName: | ENRICO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., FACP, FACE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 561781166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072475921 | ||||||||
| FaxNumber: | 5072475184 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 561781166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072475921 | ||||||||
| FaxNumber: | 5072475184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 09/13/2016 | ||||||||
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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 | 207RE0101X | 219031 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | 38557 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 4C0736 | 01 | NY | PHCS | OTHER | 28P0352 | 01 | NY | NY PRESBYTERIAN | OTHER | 166149 | 01 | NY | ELDERPLAN | OTHER | P2137433 | 01 | NY | OXFORD | OTHER | 133442196 | 01 | NY | UNITED HEALTHCARE | OTHER | 133442196 | 01 | NY | MAGNACARE | OTHER | 133442196 | 01 | NY | 1199 NATIONAL BENEFIT | OTHER | 6235251004 | 01 | NY | CIGNA | OTHER | EO08607710 | 01 | NY | EMPIRE B/C B/S | OTHER |