Provider Demographics
NPI:1235459918
Name:TIMOTEO CASTRO MD & JOSEFINA D. CASTRO MD LTD
Entity Type:Organization
Organization Name:TIMOTEO CASTRO MD & JOSEFINA D. CASTRO MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTEO
Authorized Official - Middle Name:REGUIZ
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:618-942-7371
Mailing Address - Street 1:P.O. BOX 158
Mailing Address - Street 2:321 SOUTH 13ST
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948
Mailing Address - Country:US
Mailing Address - Phone:618-942-7371
Mailing Address - Fax:618-942-8558
Practice Address - Street 1:321 SOUTH 13ST ST.
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948
Practice Address - Country:US
Practice Address - Phone:618-942-7371
Practice Address - Fax:618-942-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-51919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD47086Medicare UPIN