Provider Demographics
NPI:1104892215
Name:CASTRO, EILEEN (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 19TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3700
Mailing Address - Country:US
Mailing Address - Phone:309-779-7050
Mailing Address - Fax:309-779-7055
Practice Address - Street 1:106 19TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3700
Practice Address - Country:US
Practice Address - Phone:309-779-7050
Practice Address - Fax:309-779-7055
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1571000Medicaid
IL036104609Medicaid
IA0571000Medicaid
IA1104892215Medicaid
IL036104609OtherBC ILLINOIS
L95521Medicare ID - Type UnspecifiedINDIVIDUAL
IA1104892215Medicaid
110247170Medicare ID - Type UnspecifiedRR MEDICARE