Provider Demographics
NPI:1417989609
Name:CASTOR, STEPHEN WESLEY (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WESLEY
Last Name:CASTOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13040 MARINER DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-5974
Mailing Address - Country:US
Mailing Address - Phone:440-230-5193
Mailing Address - Fax:
Practice Address - Street 1:7055 ENGLE ROAD
Practice Address - Street 2:SUITE #404
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-243-5914
Practice Address - Fax:440-243-6530
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003029C213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2022773Medicaid
OH2022773Medicaid
U71275Medicare UPIN