Healthcare Provider Details

I. General information

NPI: 1467416628
Provider Name (Legal Business Name): JOHN JOSEPH CASTANEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 MEDICAL ARTS DRIVE
HEBRON KY
41048
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-442-6600
  • Fax: 859-442-6601
Mailing address:
  • Phone: 859-442-6600
  • Fax: 859-442-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32239
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: