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1417951211

NPI Code Detail

MEDICARE: DR. MICHAEL D CASTILLO MD

MEDICARE: DR. MICHAEL D CASTILLO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	35.132814	OH
2	207RC0000X	Cardiovascular Disease Physician	4301053638	MI
3	207RI0011X	Interventional Cardiology Physician	4301053638	MI
4	207RI0011X	Interventional Cardiology Physician	35.132814	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417951211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL D CASTILLO MD

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 W HIGH ST
Second Line	:
City	:	BRYAN
State	:	OH
Zip	:	43506-1690
Country	:	US
Telephone Number	:	419-630-2028
Fax Number	:	419-630-2029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	08/29/2024

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Directions to “ DR. MICHAEL D CASTILLO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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