Provider Demographics
NPI:1194756742
Name:CASTILLO, MELVIN EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:EDUARDO
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 1:4302 ALTON RD STE 580
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2876
Mailing Address - Country:US
Mailing Address - Phone:305-532-1989
Mailing Address - Fax:305-532-8459
Practice Address - Street 1:4302 ALTON RD STE 580
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2876
Practice Address - Country:US
Practice Address - Phone:305-532-1989
Practice Address - Fax:305-532-8459
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027923174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037189100Medicaid
FLD63300Medicare UPIN
FL037189100Medicaid