Healthcare Provider Details

I. General information

NPI: 1326380650
Provider Name (Legal Business Name): IRIS K CASTILLO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 THE BLVD STE 504
MAUMEE OH
43537-7573
US

IV. Provider business mailing address

6855 SPRING VALLEY DR
HOLLAND OH
43528-8039
US

V. Phone/Fax

Practice location:
  • Phone: 419-389-1444
  • Fax:
Mailing address:
  • Phone: 419-389-1444
  • Fax: 419-389-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.011488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: