Provider Demographics
NPI:1518176031
Name:CASTILLO, CARLO GOLEZ (DO)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:GOLEZ
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 COLONIAL LAKE DR
Mailing Address - Street 2:APT #1611
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2295
Mailing Address - Country:US
Mailing Address - Phone:205-249-4697
Mailing Address - Fax:
Practice Address - Street 1:2780 BOB WALLACE AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4104
Practice Address - Country:US
Practice Address - Phone:256-533-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016534207R00000X
ALDO.1278207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine