Healthcare Provider Details

I. General information

NPI: 1194043034
Provider Name (Legal Business Name): DEXTER RUNA CASTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2010
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S SIBLEY AVE
LITCHFIELD MN
55355-3030
US

IV. Provider business mailing address

520 S SIBLEY AVE
LITCHFIELD MN
55355-3030
US

V. Phone/Fax

Practice location:
  • Phone: 320-693-3233
  • Fax: 320-693-3290
Mailing address:
  • Phone: 320-693-3233
  • Fax: 320-693-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57378
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: