Provider Demographics
NPI:1508111584
Name:DECASTRO, CARLOS ALBERTO CAVALCANTE SR (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO CAVALCANTE
Last Name:DECASTRO
Suffix:SR
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 1:920 EVART ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601
Mailing Address - Country:US
Mailing Address - Phone:231-775-4153
Mailing Address - Fax:
Practice Address - Street 1:920 EVART ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2318
Practice Address - Country:US
Practice Address - Phone:231-775-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031752207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAD5408364OtherID NUMBER DEA