Provider Demographics
NPI:1194858746
Name:CASTANEDA, EMILIO EDGARDO (MD)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:EDGARDO
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12177 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1727
Mailing Address - Country:US
Mailing Address - Phone:954-436-0555
Mailing Address - Fax:954-436-0108
Practice Address - Street 1:12177 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1727
Practice Address - Country:US
Practice Address - Phone:954-436-0555
Practice Address - Fax:954-436-0108
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 32388207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037703100Medicaid
FL93642PMedicare PIN
FL037703100Medicaid
FLD86502Medicare UPIN