Provider Demographics
NPI:1669580221
Name:OJASCASTRO, A LOUIS (MD)
Entity type:Individual
Prefix:
First Name:A
Middle Name:LOUIS
Last Name:OJASCASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEJANDRO
Other - Middle Name:LOUIS
Other - Last Name:OJASCASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 772918
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-2918
Mailing Address - Country:US
Mailing Address - Phone:314-846-9090
Mailing Address - Fax:314-846-2968
Practice Address - Street 1:5715 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4221
Practice Address - Country:US
Practice Address - Phone:314-846-9090
Practice Address - Fax:314-846-2968
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3J90207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202678306Medicaid
MO00005220Medicare ID - Type Unspecified
MOE08990Medicare UPIN