MEDICARE: DR. AJITH R CASTELINO 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	208100000X	Physical Medicine & Rehabilitation Physician	036-099795	IL

General Provider Information

NPI Number	:	1760484042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AJITH R CASTELINO M.D.

Provider Business Mailing Address
First Line	:	50 E SCHILLER ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-2110
Country	:	US
Telephone Number	:	872-208-3095
Fax Number	:	773-961-8346

Provider Business Practice Location Address
First Line	:	6352 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1213
Country	:	US
Telephone Number	:	872-208-3095
Fax Number	:	773-961-8346

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	10/20/2021

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