Provider Demographics
NPI:1871536326
Name:CASTILLO, JANE (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-2949
Mailing Address - Fax:989-583-7536
Practice Address - Street 1:6614 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9623
Practice Address - Country:US
Practice Address - Phone:989-746-0911
Practice Address - Fax:989-583-7536
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3484964Medicaid
MI3484964Medicaid
MIM74750103Medicare PIN