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General NPI Number Information
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NPI Number | 1770144461
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Entity Type | Individual
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Provider Name | CARSON CASTELLANI
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Gender | Male
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 04/30/2023
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Provider Practice Location Address
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Address Line | 2900 W OKLAHOMA AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-4330
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Country | US
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Telephone | 414-649-6000
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Fax | 414-649-6583
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Provider Business Mailing Address
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Address Line | 540 E CANFIELD ST
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City | DETROIT
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State | MI
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Zip | 48201-1928
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 81109-20
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License Number State | WI
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