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NPI Code Detail

MEDICARE: SAMANTHA REYNA CASTILLO-MALLORY DO

MEDICARE: SAMANTHA REYNA CASTILLO-MALLORY DO
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
1207P00000XEmergency Medicine Physician036.180427IL

General Provider Information

NPI Number : 1376293845
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA REYNA CASTILLO-MALLORY DO
Provider Business Mailing Address
First Line : 1653 W CONGRESS PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3833
Country : US
Telephone Number : 312-942-5000
Fax Number :
Provider Business Practice Location Address
First Line : 1653 W CONGRESS PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3833
Country : US
Telephone Number : 312-942-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2022
Last Update Date : 06/04/2026

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