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NPI Code Detail

MEDICARE: DR. CANDELARIA J M CASTANEDA MD

MEDICARE: DR. CANDELARIA J M CASTANEDA 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
1207R00000XInternal Medicine Physician4301062431MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P92434OTHERBLUECARE NETWORK

General Provider Information

NPI Number : 1689667354
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CANDELARIA J M CASTANEDA MD
Provider Business Mailing Address
First Line : 2254 E MAIN ST
Second Line :
City : UBLY
State : MI
Zip : 48475-9566
Country : US
Telephone Number : 989-658-9191
Fax Number : 989-658-2231
Provider Business Practice Location Address
First Line : 4675 HILL ST
Second Line :
City : CASS CITY
State : MI
Zip : 48726-1008
Country : US
Telephone Number : 989-872-2121
Fax Number : 989-872-5376
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2005
Last Update Date : 01/27/2015

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