Provider Demographics
NPI:1659540953
Name:CANDELARIA CASTANEDA, MD, PLLC
Entity Type:Organization
Organization Name:CANDELARIA CASTANEDA, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDELARIA
Authorized Official - Middle Name:J M
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-479-3116
Mailing Address - Street 1:729 TRESCOTT ST
Mailing Address - Street 2:P.O. BOX 213
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-1321
Mailing Address - Country:US
Mailing Address - Phone:989-479-3116
Mailing Address - Fax:989-479-3860
Practice Address - Street 1:729 TRESCOTT ST
Practice Address - Street 2:
Practice Address - City:HARBOR BEACH
Practice Address - State:MI
Practice Address - Zip Code:48441-1321
Practice Address - Country:US
Practice Address - Phone:989-479-3116
Practice Address - Fax:989-479-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP92434OtherBLUE CARE NETWORK
MI3464809Medicaid
MI3464809Medicaid
MIP92434OtherBLUE CARE NETWORK
MIF71853Medicare UPIN
MI0P54340Medicare PIN