Basic Information
| Provider Information | |||||||||
| NPI: | 1194043034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTA | ||||||||
| FirstName: | DEXTER | ||||||||
| MiddleName: | RUNA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 S SIBLEY AVE | ||||||||
| Address2: | |||||||||
| City: | LITCHFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553553030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206933233 | ||||||||
| FaxNumber: | 3206933290 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 S SIBLEY AVE | ||||||||
| Address2: | |||||||||
| City: | LITCHFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553553030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206933233 | ||||||||
| FaxNumber: | 3206933290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2010 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57378 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.