MEDICARE: EMILY BERNIECE CASTILLO PA-C

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	363A00000X	Physician Assistant	5601013185	MI

General Provider Information

NPI Number	:	1659164341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY BERNIECE CASTILLO PA-C

Provider Business Mailing Address
First Line	:	9683 FAWN RUN
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-7541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-2707
Country	:	US
Telephone Number	:	517-787-5350
Fax Number	:

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

Provider Enumeration Date	:	05/26/2025
Last Update Date	:	05/26/2025

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Directions to “ EMILY BERNIECE CASTILLO PA-C” Practice Location

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