Provider Demographics
NPI:1992908594
Name:CASTILLO, MICHAEL PATRICIO (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICIO
Last Name:CASTILLO
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 1:10740 N GESSNER DR
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:10970 SHADOW CREEK PKWY STE 360
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-0123
Practice Address - Country:US
Practice Address - Phone:713-436-8071
Practice Address - Fax:713-436-4030
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6068207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195172501Medicaid
TX1951725-03Medicaid
TX2548845OtherBEECHSTREET
TX1951725-02Medicaid
TX1951725-03Medicaid
TX8L18034Medicare PIN
TX8L2503Medicare PIN
TX195172501Medicaid