Healthcare Provider Details

I. General information

NPI: 1750562534
Provider Name (Legal Business Name): MICHAEL A CASTILLO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
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: 602-680-8002
  • Fax: 602-242-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number27636
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number27636
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number27636
License Number StateAZ

VIII. Authorized Official

Name: STEPHANIE CASTILLO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 602-242-9891