Healthcare Provider Details

I. General information

NPI: 1053728238
Provider Name (Legal Business Name): MICHAEL CASTELLANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2014
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 PINE HAVEN DR
ST JOHNS FL
32259-7409
US

IV. Provider business mailing address

7235 NW 4TH ST
MIAMI FL
33126-4213
US

V. Phone/Fax

Practice location:
  • Phone: 305-970-9108
  • Fax:
Mailing address:
  • Phone: 305-970-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberME138187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: