MEDICARE: CASTLEMAN EMERGENCY CENTER PC

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	261QA1903X	Ambulatory Surgical Clinic/Center

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
2	40370	OTHER		BCBS

General Provider Information

NPI Number	:	1356323208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLEMAN EMERGENCY CENTER PC

Provider Business Mailing Address
First Line	:	14050 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2501
Country	:	US
Telephone Number	:	734-283-0500
Fax Number	:	734-283-2720

Provider Business Practice Location Address
First Line	:	14050 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2501
Country	:	US
Telephone Number	:	734-283-0500
Fax Number	:	734-283-2720

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAWRENCE D CASTLEMAN
Credential	:	MD
Telephone Number	:	734-283-0500

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/22/2020

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