Provider Demographics
NPI:1588736847
Name:ISABELO CASTILLO, MDSC
Entity type:Organization
Organization Name:ISABELO CASTILLO, MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABELO
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-837-2100
Mailing Address - Street 1:501 E GRANT ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3374
Mailing Address - Country:US
Mailing Address - Phone:309-837-2100
Mailing Address - Fax:309-837-5800
Practice Address - Street 1:501 E GRANT ST
Practice Address - Street 2:UNIT 4
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3374
Practice Address - Country:US
Practice Address - Phone:309-837-2100
Practice Address - Fax:309-837-5800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISABELO CASTILLO, MDSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-14
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL036089354261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089354Medicaid
IL036089354Medicaid
ILF88265Medicare UPIN