Provider Demographics
NPI:1861722910
Name:JULIAN V CASTILLO JR PSC
Entity type:Organization
Organization Name:JULIAN V CASTILLO JR PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:859-234-3314
Mailing Address - Street 1:1210 KY HIGHWAY 36 E
Mailing Address - Street 2:SUITE G1
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7490
Mailing Address - Country:US
Mailing Address - Phone:859-234-3314
Mailing Address - Fax:859-234-3315
Practice Address - Street 1:1210 KY HIGHWAY 36 E
Practice Address - Street 2:SUITE G1
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7490
Practice Address - Country:US
Practice Address - Phone:859-234-3314
Practice Address - Fax:859-234-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17307208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64173073Medicaid
KY64173073Medicaid