Individual
LAURA DECASTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 335-5000
(574) 335-0760
Mailing address
PO BOX 6309, SOUTH BEND, IN 46660-6309
(574) 335-8707
(574) 335-0750
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
4301049652
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200872670
—
IN
05
—
2844302-10
—
MI
Enumeration date
11/15/2006
Last updated
10/10/2014
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