Provider Demographics
NPI:1841411741
Name:NOEL CASTELINO SC
Entity Type:Organization
Organization Name:NOEL CASTELINO SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AJITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASTELINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-673-4800
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:847-673-4800
Mailing Address - Fax:847-673-9322
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099795225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099795Medicaid
210577Medicare ID - Type Unspecified