Provider Demographics
NPI:1952485799
Name:CASTANO, LUIS (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:CASTANO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 NW 79TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-4602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3448 NW 79TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4602
Practice Address - Country:US
Practice Address - Phone:786-949-6347
Practice Address - Fax:866-285-7068
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274814200Medicaid
FLU7217ZMedicare ID - Type Unspecified
FL274814200Medicaid