Healthcare Provider Details

I. General information

NPI: 1467564294
Provider Name (Legal Business Name): R CASTILLO MD AND L RAMOS-CASTILLO MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21W480 ARMY TRAIL RD
ADDISON IL
60101-1404
US

IV. Provider business mailing address

21W480 ARMY TRAIL RD
ADDISON IL
60101-1404
US

V. Phone/Fax

Practice location:
  • Phone: 630-932-1870
  • Fax: 630-932-8191
Mailing address:
  • Phone: 630-932-1870
  • Fax: 630-932-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02232692
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS OF IL

VIII. Authorized Official

Name: DR. RAMON MERCADO CASTILLO
Title or Position: DIRECTOR
Credential: M.D.
Phone: 630-932-1870