Provider Demographics
NPI:1689829376
Name:CASTRO, FIDEL EDMUNDO (M D)
Entity Type:Individual
Prefix:
First Name:FIDEL
Middle Name:EDMUNDO
Last Name:CASTRO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:929 N SAINT FRANCIS ST
Mailing Address - Street 2:EMERGENCY DEPT.
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3821
Mailing Address - Country:US
Mailing Address - Phone:316-268-5775
Mailing Address - Fax:316-291-7496
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5775
Practice Address - Fax:316-291-7496
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-34439207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT191671OtherCOMMONWEALTH OF PENNSYLVANIA
KS04-34439OtherKS LICENSE
KS200656080AMedicaid
KS04-34439OtherKS LICENSE