Provider Demographics
NPI:1255450698
Name:CASTREJON, MIGUEL J (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:J
Last Name:CASTREJON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MIGUEL
Other - Middle Name:J
Other - Last Name:CASTREJON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1755 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7913
Mailing Address - Country:US
Mailing Address - Phone:719-471-3058
Mailing Address - Fax:719-634-4660
Practice Address - Street 1:1755 S 8TH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-7913
Practice Address - Country:US
Practice Address - Phone:719-471-3058
Practice Address - Fax:719-634-4660
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44886208100000X
CAA72472208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation