Healthcare Provider Details

I. General information

NPI: 1356265102
Provider Name (Legal Business Name): MASON CASTRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 N SAINT JOSEPH AVE
NILES MI
49120-2263
US

IV. Provider business mailing address

24 N SAINT JOSEPH AVE
NILES MI
49120-2263
US

V. Phone/Fax

Practice location:
  • Phone: 269-683-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: