Provider Demographics
NPI:1760484042
Name:CASTELINO, AJITH R (MD)
Entity Type:Individual
Prefix:DR
First Name:AJITH
Middle Name:R
Last Name:CASTELINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:50 E SCHILLER ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2110
Mailing Address - Country:US
Mailing Address - Phone:872-208-3095
Mailing Address - Fax:773-961-8346
Practice Address - Street 1:6352 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1213
Practice Address - Country:US
Practice Address - Phone:872-208-3095
Practice Address - Fax:773-961-8346
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099795208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG98957Medicare UPIN
ILK13175/210577Medicare ID - Type Unspecified