Provider Demographics
NPI:1811999840
Name:CAST, WILLIAM R (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:CAST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11141 PARKVIEW PLAZA DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:260-484-0919
Mailing Address - Fax:260-483-3097
Practice Address - Street 1:11141 PARKVIEW PLAZA DR
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-484-0919
Practice Address - Fax:260-483-3097
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01019734A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0487478Medicaid
OH0487478Medicaid