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General NPI Number Information
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NPI Number | 1841306982
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Entity Type | Individual
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Provider Name | JUVENAL LIPANA CASTILLO MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 6172 CHABLIS LN
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City | PORTAGE
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State | MI
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Zip | 49024-9005
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Country | US
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Telephone | 917-816-4427
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Fax | 269-321-0156
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Provider Business Mailing Address
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Address Line | 6172 CHABLIS LN
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City | PORTAGE
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State | MI
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Zip | 49024-9005
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Country | US
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Telephone | 917-816-4427
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Fax | 269-321-0156
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4301087182
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036116406
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License Number State | IL
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