Provider Demographics
NPI:1366023806
Name:CASTILLO CRUZ, LIDIA ESTHER (MD)
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:ESTHER
Last Name:CASTILLO CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-559-9407
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:12955 SHELBYVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1538
Practice Address - Country:US
Practice Address - Phone:502-245-4301
Practice Address - Fax:502-394-3632
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY59333207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine