Provider Demographics
NPI:1124088943
Name:CASTILLO, ISABELO CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:ISABELO
Middle Name:CHRISTOPHER
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E. GRANT STREET
Mailing Address - Street 2:UNIT 4
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3375
Mailing Address - Country:US
Mailing Address - Phone:309-837-2100
Mailing Address - Fax:
Practice Address - Street 1:501 E GRANT ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3375
Practice Address - Country:US
Practice Address - Phone:309-837-2100
Practice Address - Fax:309-387-5800
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL306089354208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089354Medicaid
IL371343625OtherTAX ID NUMBER
IL349810Medicare ID - Type Unspecified
IL036089354Medicaid