Provider Demographics
NPI:1528260429
Name:CASTLEMAN, SUE (DO)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:
Last Name:CASTLEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837-2693
Mailing Address - Country:US
Mailing Address - Phone:208-783-1267
Mailing Address - Fax:208-786-4471
Practice Address - Street 1:740 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2693
Practice Address - Country:US
Practice Address - Phone:208-783-1267
Practice Address - Fax:208-786-4471
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0262334OtherWASHINGTON L&I
ID808660700Medicaid
IDS6495OtherBLUE CROSS OF IDAHO
ID1302934Medicare PIN