Provider Demographics
NPI:1932138815
Name:CASTELLANI, RUDOLPH J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:J
Last Name:CASTELLANI
Suffix:JR
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 1:710 N FAIRBANKS CT STE 2-462
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3013
Mailing Address - Country:US
Mailing Address - Phone:312-503-8144
Mailing Address - Fax:312-503-8249
Practice Address - Street 1:710 N FAIRBANKS CT STE 2-462
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3013
Practice Address - Country:US
Practice Address - Phone:312-503-8144
Practice Address - Fax:312-503-8249
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28274207ZP0101X
MDD0047847207ZP0101X
IL036157610207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG12511Medicare UPIN
MDM566Medicare PIN
MDCA9059Medicare PIN
MD220017404Medicare PIN