Provider Demographics
NPI:1639513179
Name:CASTANO, KELLY (DVM)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:CASTANO
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FILLMORE ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2247
Mailing Address - Country:US
Mailing Address - Phone:856-404-2673
Mailing Address - Fax:
Practice Address - Street 1:2551 WARRENVILLE RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1724
Practice Address - Country:US
Practice Address - Phone:630-963-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-27
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090010992174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL090010992OtherDVM LICENSE