Provider Demographics
NPI:1306834338
Name:CASTRO, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8900 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1958
Mailing Address - Country:US
Mailing Address - Phone:310-432-8900
Mailing Address - Fax:310-432-8901
Practice Address - Street 1:10001 VENICE BLVD APT 402
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-7439
Practice Address - Country:US
Practice Address - Phone:808-445-4085
Practice Address - Fax:866-438-4310
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY174662207RX0202X
HI15323207RX0202X
CA144118207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01251532Medicaid
NY01251532Medicaid
CC6356Medicare PIN
E95286Medicare UPIN