Healthcare Provider Details

I. General information

NPI: 1417989609
Provider Name (Legal Business Name): STEPHEN WESLEY CASTOR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 ENGLE ROAD SUITE #404
MIDDLEBURG HEIGHTS OH
44130
US

IV. Provider business mailing address

13040 MARINER DRIVE
NORTH ROYALTON OH
44133-5974
US

V. Phone/Fax

Practice location:
  • Phone: 440-243-5914
  • Fax: 440-243-6530
Mailing address:
  • Phone: 440-230-5193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003029C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: