Individual
DR. CARLOS CASTANEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
(708) 795-3159
Mailing address
211 E OHIO ST APT 816, CHICAGO, IL 60611-3225
(312) 399-8160
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01062180A
IN
207P00000X
Emergency Medicine Physician
036115939
IL
207P00000X
Emergency Medicine Physician
Primary
N3541
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01062180A
INDIANA LICENSE
IN
05
—
036115939
—
IL
01
—
1053368878
TRICARE SOUTH
TX
05
—
206743101
—
TX
01
—
8CD082
BCBSTX
TX
Enumeration date
05/27/2006
Last updated
11/11/2010
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