Provider Demographics
NPI:1700805454
Name:CASTILLO, THOMAS A (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:240 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3115
Mailing Address - Country:US
Mailing Address - Phone:920-887-1151
Mailing Address - Fax:920-887-3353
Practice Address - Street 1:240 CORPORATE DRIVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3115
Practice Address - Country:US
Practice Address - Phone:920-887-1151
Practice Address - Fax:920-887-3353
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI40496207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
391156156OtherTAX ID
WI180034885OtherRAIL ROAD MEDICARE
31662OtherNETWORK HEALTH PLAN
WI30088300Medicaid
11995OtherDEAN CARE HMO
1024501OtherPHYSICIANS PLUS HMO
39115615613OtherUNITY HMO
WI0113OtherJOHN DEERE HEALTH PLAN
31662OtherNETWORK HEALTH PLAN
WI180034885OtherRAIL ROAD MEDICARE