Provider Demographics
NPI:1831778331
Name:NICASTRO, TONI (DO)
Entity type:Individual
Prefix:DR
First Name:TONI
Middle Name:
Last Name:NICASTRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6770
Mailing Address - Country:US
Mailing Address - Phone:248-551-3000
Mailing Address - Fax:248-551-2032
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-3000
Practice Address - Fax:248-551-2032
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2022-11-23
Deactivation Date:2022-05-05
Deactivation Code:
Reactivation Date:2022-06-03
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5151015562208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program