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NPI Code Detail

MEDICARE: DAVID EDUARDO CASILLAS PLAZOLA MD

MEDICARE: DAVID EDUARDO CASILLAS PLAZOLA MD
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
1207Q00000XFamily Medicine Physician75093-20WI

General Provider Information

NPI Number : 1598228314
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID EDUARDO CASILLAS PLAZOLA MD
Provider Business Mailing Address
First Line : 507 S MONROE ST
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2099
Country : US
Telephone Number : 608-723-2143
Fax Number :
Provider Business Practice Location Address
First Line : 507 S MONROE ST
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2099
Country : US
Telephone Number : 608-723-2143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2019
Last Update Date : 06/30/2022

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