Provider Demographics
NPI:1083886279
Name:CASTILLO-JUAT MEDICAL GROUP SC
Entity Type:Organization
Organization Name:CASTILLO-JUAT MEDICAL GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNABELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO-JUAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-528-8372
Mailing Address - Street 1:3019 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4207
Mailing Address - Country:US
Mailing Address - Phone:773-528-8372
Mailing Address - Fax:773-528-8372
Practice Address - Street 1:3019 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4207
Practice Address - Country:US
Practice Address - Phone:773-528-8372
Practice Address - Fax:773-528-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL382220OtherMEDICARE GROUP NUMBER
IL21604249OtherBCBS
IL21604249OtherBCBS
ILD12627Medicare UPIN