Provider Demographics
NPI:1205801313
Name:CASTILLO, SAMUEL F (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:F
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 1:2222 W DIVISION ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2717
Mailing Address - Country:US
Mailing Address - Phone:773-342-6800
Mailing Address - Fax:773-342-6332
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 235
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-342-6800
Practice Address - Fax:773-342-6332
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122662207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036122662Medicaid
MNP00198298Medicare ID - Type UnspecifiedRAILROAD
I17297Medicare UPIN
IL036122662Medicaid