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General NPI Number Information
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NPI Number | 1861905739
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Entity Type | Organization
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Legal Business Name | JACASTILLANO PLLC
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 02/02/2025
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Provider Practice Location Address
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Address Line | 5310 BREEZE HILL PL
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City | TROY
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State | MI
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Zip | 48098-2725
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Country | US
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Telephone | 904-252-3930
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Fax |
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Provider Business Mailing Address
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Address Line | 54626 MORNINGSIDE DR
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-6001
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Country | US
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Telephone | 904-252-3930
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JESSE A CASTILLANO
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Credential | MD
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Telephone | 904-252-3930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 4301100455
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License Number State | MI
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