Healthcare Provider Details

I. General information

NPI: 1013619758
Provider Name (Legal Business Name): CHRISTOPHER CASTELOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR # MA111
COLUMBIA MO
65212-1538
US

IV. Provider business mailing address

1901 FIELD ST
COLUMBIA MO
65203-8735
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-1767
  • Fax:
Mailing address:
  • Phone: 941-703-5978
  • 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: