Provider Demographics
NPI:1477539799
Name:CASTRO, REYNALDO MAGDANGAL (MD)
Entity Type:Individual
Prefix:
First Name:REYNALDO
Middle Name:MAGDANGAL
Last Name:CASTRO
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 1:550 30TH AVE
Mailing Address - Street 2:STE 12
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5975
Mailing Address - Country:US
Mailing Address - Phone:309-762-5515
Mailing Address - Fax:309-762-5519
Practice Address - Street 1:550 30TH AVE
Practice Address - Street 2:STE 12
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5975
Practice Address - Country:US
Practice Address - Phone:309-762-5515
Practice Address - Fax:309-762-5519
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL491170Medicare PIN
ILG79942Medicare UPIN