Healthcare Provider Details

I. General information

NPI: 1760778047
Provider Name (Legal Business Name): KEVIN CASTILLO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 E MARKET ST
WARREN OH
44483-6613
US

IV. Provider business mailing address

1622 E MARKET ST
WARREN OH
44483-6613
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-7215
  • Fax:
Mailing address:
  • Phone: 330-399-7215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number34.011963
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: