MEDICARE: JOSE J CASTELLANOS 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	173000000X	Legal Medicine	036073558	IL
2	207Q00000X	Family Medicine Physician	036073558	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01616720	OTHER		BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750302386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE J CASTELLANOS MD

Provider Business Mailing Address
First Line	:	PO BOX 577489
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-7335
Country	:	US
Telephone Number	:	872-226-9199
Fax Number	:	773-509-9006

Provider Business Practice Location Address
First Line	:	4941 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5009
Country	:	US
Telephone Number	:	773-509-9099
Fax Number	:	773-509-9006

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/21/2014

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Directions to “ JOSE J CASTELLANOS MD” Practice Location

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