Provider Demographics
NPI:1508838145
Name:CASTELLANO, ABEL R (MD)
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:R
Last Name:CASTELLANO
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 1:481 E DIVISION ST
Mailing Address - Street 2:PO BOX 910
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3748
Mailing Address - Country:US
Mailing Address - Phone:920-921-5676
Mailing Address - Fax:920-921-2684
Practice Address - Street 1:481 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3748
Practice Address - Country:US
Practice Address - Phone:920-921-5676
Practice Address - Fax:920-921-2684
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI377502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G26058Medicare UPIN