Provider Demographics
NPI:1467503672
Name:CASTILLO, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W DIVISION ST
Mailing Address - Street 2:235
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2717
Mailing Address - Country:US
Mailing Address - Phone:773-342-6800
Mailing Address - Fax:773-342-6332
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:235
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-342-6800
Practice Address - Fax:773-342-6332
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063975207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063975Medicaid
IL036063975Medicaid
ILD14997Medicare UPIN
IL692861Medicare ID - Type UnspecifiedMEDICARE ID