Provider Demographics
NPI:1003058330
Name:CASTRO, MADELINE DE LOS MILAGROS (MD)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:DE LOS MILAGROS
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 NE 2ND AVE
Mailing Address - Street 2:APT B-8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2706
Mailing Address - Country:US
Mailing Address - Phone:305-795-8494
Mailing Address - Fax:305-762-1530
Practice Address - Street 1:971 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1205
Practice Address - Country:US
Practice Address - Phone:305-545-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001445500Medicaid
FLC04192OtherMEDICARE PTAN