Provider Demographics
NPI:1770017048
Name:SANHUEZA CASTILLO, NICOLAS RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:RODOLFO
Last Name:SANHUEZA CASTILLO
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 1:731 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1225
Mailing Address - Country:US
Mailing Address - Phone:608-776-4497
Mailing Address - Fax:608-776-2837
Practice Address - Street 1:731 CLAY ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1225
Practice Address - Country:US
Practice Address - Phone:608-776-4497
Practice Address - Fax:608-776-2837
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100094497Medicaid