Basic Information
Provider Information
NPI: 1023496643
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASTEEL
FirstName: MICHAEL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.P.M.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1020 LAKE SUMTER LNDG
Address2:  
City: THE VILLAGES
State: FL
PostalCode: 321622699
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2955 BROWNWOOD BLVD
Address2:  
City: THE VILLAGES
State: FL
PostalCode: 321632036
CountryCode: US
TelephoneNumber: 3526748700
FaxNumber: 3526748714
Other Information
ProviderEnumerationDate: 05/14/2015
LastUpdateDate: 01/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213E00000XPO3996FLY Podiatric Medicine & Surgery Service ProvidersPodiatrist 

No ID Information.


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