Provider Demographics
NPI:1316361199
Name:MICHAEL A CASTILLO MD, PC
Entity Type:Organization
Organization Name:MICHAEL A CASTILLO MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VENDT-HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-242-9891
Mailing Address - Street 1:5310 W THUNDERBIRD RD STE 215
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4712
Mailing Address - Country:US
Mailing Address - Phone:602-680-8002
Mailing Address - Fax:602-242-9895
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 215
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4712
Practice Address - Country:US
Practice Address - Phone:602-680-8002
Practice Address - Fax:602-242-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ517419Medicaid