Healthcare Provider Details

I. General information

NPI: 1942094446
Provider Name (Legal Business Name): JOSE CASTANEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37595 7 MILE RD STE 210
LIVONIA MI
48152-1489
US

IV. Provider business mailing address

3079 S BALDWIN RD # 1072
LAKE ORION MI
48359-1028
US

V. Phone/Fax

Practice location:
  • Phone: 734-430-9388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: