Provider Demographics
NPI:1750759890
Name:CASTLE, FREDERICK JAMES JR
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:JAMES
Last Name:CASTLE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5765 SOMERSET DR APT B7
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:MI
Mailing Address - Zip Code:48808-7414
Mailing Address - Country:US
Mailing Address - Phone:517-223-1262
Mailing Address - Fax:517-223-4483
Practice Address - Street 1:11229 HIGH TIMBERS DR
Practice Address - Street 2:
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-9609
Practice Address - Country:US
Practice Address - Phone:517-223-1262
Practice Address - Fax:517-223-4483
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI352229132343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)