Provider Demographics
NPI:1922095884
Name:CASTILLO, CARLOS M (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:M
Last Name: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 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7751 BAYMEADOWS RD E STE 205
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-427-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL(FLA)ME070579207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013213OtherWELLCARE
FLP0022960OtherFLORIDA HEALTHCARE PLUS
FL28281OtherWELLCARE
FL251900300Medicaid
FL38097OtherBCBS
FL1251265OtherWELLCARE
FLP01383297OtherRR MEDICARE
FLPRV0007644OtherPREFERRED MED-THRU KEYS PHO
FL1100410OtherCAREPLUS
FL1251265OtherSTAYWELL (MEDICAID) AND WELLCARE (MEDICARE)
FL225104OtherAVMED
FL5867626OtherAETNA
FLP10706223OtherSIMPLY HEALTHCARE
FL38097VMedicare PIN
FL38097OtherBCBS
FL225104OtherAVMED
FL1251265OtherSTAYWELL (MEDICAID) AND WELLCARE (MEDICARE)
FL38097XMedicare PIN
FL380972Medicare PIN