Provider Demographics
NPI:1497744148
Name:CASTANEDA, JUANITA M (MD)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:M
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 BRAINARD RD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4608
Mailing Address - Country:US
Mailing Address - Phone:216-214-6176
Mailing Address - Fax:440-494-7049
Practice Address - Street 1:2804 BRAINARD RD
Practice Address - Street 2:
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44124-4608
Practice Address - Country:US
Practice Address - Phone:216-214-6176
Practice Address - Fax:440-494-7049
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000332689OtherANTHEM
OH0536067Medicaid
OH110031418OtherRAILROAD MEDICARE
OH000000124452OtherANTHEM
OHP00198029OtherRAILROAD MEDICARE
OH000000124452OtherANTHEM
OH000000332689OtherANTHEM