Provider Demographics
NPI:1740631183
Name:PORTALES CASTILLO, IGNACIO ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:ALBERTO
Last Name:PORTALES CASTILLO
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Gender:
Credentials:MD
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-7603
Mailing Address - Fax:314-747-5213
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV IM NEPHROLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-7603
Practice Address - Fax:314-747-5213
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2025-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2021040899207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200110124Medicaid