Basic Information
| Provider Information | |||||||||
| NPI: | 1528260429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTLEMAN | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 MCKINLEY AVE | ||||||||
| Address2: | |||||||||
| City: | KELLOGG | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838372693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087831267 | ||||||||
| FaxNumber: | 2087864471 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 MCKINLEY AVE | ||||||||
| Address2: | |||||||||
| City: | KELLOGG | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838372693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087831267 | ||||||||
| FaxNumber: | 2087864471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2007 | ||||||||
| LastUpdateDate: | 06/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | O-0562 | ID | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0262334 | 01 | ID | WASHINGTON L&I | OTHER | 808660700 | 05 | ID | MEDICAID | S6495 | 01 | ID | BLUE CROSS OF IDAHO | OTHER |