Provider Demographics
NPI:1962516690
Name:CASTRO, ALAN SANTILLAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SANTILLAN
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1300 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4232
Mailing Address - Country:US
Mailing Address - Phone:440-838-4363
Mailing Address - Fax:216-834-0010
Practice Address - Street 1:8180 BRECKSVILLE RD
Practice Address - Street 2:# 115
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1374
Practice Address - Country:US
Practice Address - Phone:216-834-0010
Practice Address - Fax:216-834-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 06 9277 C2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA0832981Medicare ID - Type Unspecified
G58911Medicare UPIN