MEDICARE: SAMUEL F CASTILLO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	036122662	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205801313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL F CASTILLO M.D.

Provider Business Mailing Address
First Line	:	2222 W DIVISION ST
Second Line	:	SUITE 235
City	:	CHICAGO
State	:	IL
Zip	:	60622-2717
Country	:	US
Telephone Number	:	773-342-6800
Fax Number	:	773-342-6332

Provider Business Practice Location Address
First Line	:	2222 W DIVISION ST
Second Line	:	SUITE 235
City	:	CHICAGO
State	:	IL
Zip	:	60622-2717
Country	:	US
Telephone Number	:	773-342-6800
Fax Number	:	773-342-6332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	03/30/2021

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