Provider Demographics
NPI:1598752602
Name:CASTRO, MANUEL ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ANGEL
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1881 NE 26TH ST
Mailing Address - Street 2:SUITE 40
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1416
Mailing Address - Country:US
Mailing Address - Phone:954-567-2488
Mailing Address - Fax:954-567-2490
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:SUITE 40
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:954-567-2488
Practice Address - Fax:954-567-2490
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0073728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11494463OtherCAQH
FLG62186Medicare UPIN