Provider Demographics
NPI:1588749295
Name:CASTRO, ANTONIO R (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:R
Last Name:CASTRO
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 1:8175 NW 12TH ST
Mailing Address - Street 2:SUITE 306 (ATTN.: J. BASSI)
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1828
Mailing Address - Country:US
Mailing Address - Phone:786-845-0164
Mailing Address - Fax:786-845-0176
Practice Address - Street 1:8175 NW 12TH ST
Practice Address - Street 2:SUITE 306 (ATTN.: J. BASSI)
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1828
Practice Address - Country:US
Practice Address - Phone:786-845-0164
Practice Address - Fax:786-845-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78190Medicare ID - Type Unspecified