MEDICARE: DR. MARK M CASILLAS M.D.

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	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	J1917	TX
2	207X00000X	Orthopaedic Surgery Physician	J1917	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00088532	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5972563	OTHER	TX	AETNA
2	8K6270	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1676698	OTHER	TX	CIGNA

General Provider Information

NPI Number	:	1598709305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK M CASILLAS M.D.

Provider Business Mailing Address
First Line	:	1139 E SONTERRA BLVD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4349
Country	:	US
Telephone Number	:	210-874-3359
Fax Number	:	210-874-3369

Provider Business Practice Location Address
First Line	:	1139 E SONTERRA BLVD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4349
Country	:	US
Telephone Number	:	210-874-3359
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	02/10/2022

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Directions to “ DR. MARK M CASILLAS M.D.” Practice Location

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