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General NPI Number Information
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NPI Number | 1205832243
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Entity Type | Individual
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Provider Name | VENANCIO DECASTRO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 1430 N ARLINGTON HEIGHTS RD SUITE 206
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-4830
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Country | US
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Telephone | 847-259-8226
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Fax | 847-392-5260
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Provider Business Mailing Address
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Address Line | 600 W LAKE COOK RD SUITE 110
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-2089
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Country | US
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Telephone | 847-459-6495
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Fax | 847-459-7929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | IL
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