Provider Demographics
NPI:1154378230
Name:CASTILLO, BLACHAR & BRASAC, M.D.,P.A.
Entity type:Organization
Organization Name:CASTILLO, BLACHAR & BRASAC, M.D.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-532-1989
Mailing Address - Street 1:4302 ALTON ROAD
Mailing Address - Street 2:SUITE 580
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140
Mailing Address - Country:US
Mailing Address - Phone:305-532-1989
Mailing Address - Fax:305-532-8459
Practice Address - Street 1:4302 ALTON ROAD
Practice Address - Street 2:SUITE 580
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140
Practice Address - Country:US
Practice Address - Phone:305-532-1989
Practice Address - Fax:305-532-8459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374543100Medicaid
FL374543100Medicaid