Provider Demographics
NPI:1982669198
Name:CASTRO, JILL (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9250 E COSTILLA AVE STE 540
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3648
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:12230 LIONESS WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5603
Practice Address - Country:US
Practice Address - Phone:720-644-9355
Practice Address - Fax:303-334-1490
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39676208100000X
CODR.0039676208100000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26159244Medicaid
COC444098Medicare PIN
CO26159244Medicaid