Provider Demographics
NPI:1265648299
Name:WESTGATE, DIANA CASTANON (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:CASTANON
Last Name:WESTGATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:535 S BURDICK ST STE 256
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-6112
Practice Address - Country:US
Practice Address - Phone:269-290-1901
Practice Address - Fax:269-290-1913
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01079479A207N00000X
MI4301088557207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M02830202Medicare PIN
MIMI3233127Medicare PIN