Provider Demographics
NPI:1205814092
Name:CASTINE, MICHAEL JULES III (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JULES
Last Name:CASTINE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:8595 PICARDY AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3670
Practice Address - Country:US
Practice Address - Phone:225-767-0822
Practice Address - Fax:225-769-5424
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA12998R207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1554111Medicaid
5E482Medicare PIN
F66731Medicare UPIN
LA1554111Medicaid