Provider Demographics
NPI:1891063053
Name:DE CASTRO, WILBERTO CANLAS
Entity Type:Individual
Prefix:DR
First Name:WILBERTO
Middle Name:CANLAS
Last Name:DE CASTRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9715
Mailing Address - Country:US
Mailing Address - Phone:815-469-2611
Mailing Address - Fax:
Practice Address - Street 1:558 ABERDEEN RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9715
Practice Address - Country:US
Practice Address - Phone:815-469-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.047315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine