Healthcare Provider Details

I. General information

NPI: 1639150865
Provider Name (Legal Business Name): CONRADO PELAYO CASTOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 FRAN LIN PKWY
MUNSTER IN
46321-3540
US

IV. Provider business mailing address

911 FRAN LIN PKWY
MUNSTER IN
46321-3540
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1980
  • Fax: 219-836-2133
Mailing address:
  • Phone: 219-836-1980
  • Fax: 219-836-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01027402
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: