Healthcare Provider Details

I. General information

NPI: 1619991643
Provider Name (Legal Business Name): MICHAEL ALLEN CASTILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11851 N 51ST AVE STE D120
GLENDALE AZ
85304-2839
US

IV. Provider business mailing address

11851 N 51ST AVE STE D120
GLENDALE AZ
85304-2839
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-9891
  • Fax: 602-242-9895
Mailing address:
  • Phone: 602-242-9891
  • Fax: 602-242-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number27636
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number27636
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number27636
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: