Provider Demographics
NPI:1639150865
Name:CASTOR, CONRADO PELAYO (MD)
Entity Type:Individual
Prefix:DR
First Name:CONRADO
Middle Name:PELAYO
Last Name:CASTOR
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 1:911 FRAN LIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3540
Mailing Address - Country:US
Mailing Address - Phone:219-836-1980
Mailing Address - Fax:219-836-2133
Practice Address - Street 1:911 FRAN LIN PKWY
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3540
Practice Address - Country:US
Practice Address - Phone:219-836-1980
Practice Address - Fax:219-836-2133
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-05
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027402207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100202180Medicaid
IN627980Medicare ID - Type Unspecified
IN100202180Medicaid