Provider Demographics
NPI:1144256926
Name:CASTELLANOS, MIGUEL E (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:E
Last Name:CASTELLANOS
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 1:610 STRICKLAND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-4786
Mailing Address - Country:US
Mailing Address - Phone:409-886-7245
Mailing Address - Fax:409-883-7450
Practice Address - Street 1:610 STRICKLAND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4786
Practice Address - Country:US
Practice Address - Phone:409-886-7245
Practice Address - Fax:409-883-7450
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9311207RC0000X
TXL05204207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136831802Medicaid
TX136831803Medicaid
TX892695Medicare ID - Type Unspecified
TX136831802Medicaid
TX136831803Medicaid