Basic Information
| Provider Information | |||||||||
| NPI: | 1063490381 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTILLO | ||||||||
| FirstName: | SANTIAGO | ||||||||
| MiddleName: | SINGSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2857 MANLEY RD | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435379654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193200504 | ||||||||
| FaxNumber: | 4198681525 | ||||||||
| Practice Location | |||||||||
| Address1: | 3535 OLENTANGY RIVER ROAD | ||||||||
| Address2: | PATHOLOGY DEPARTMENT | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145664945 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 02/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 35-060060 | OH | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 2474755 | 05 | OH | MEDICAID | NM009T91 | 01 | NM | BC/BS | OTHER | 1811436000 | 05 | WV | MEDICAID | 934663 | 01 | AZ | AHCCCS | OTHER | 201050986 | 01 | NM | PRESBYTERIAN HEALTH/SALUD | OTHER | 10020366 | 01 | NM | LOVELACE HEALTH/SALUD | OTHER |