| Chicago Gi | |
|
1431 N Western Ave Suite 133 Chicago IL 60622-1797 | |
| (773) 342-6800 | |
| (773) 342-6332 |
| Full Name | Chicago Gi |
|---|---|
| Speciality | Internal Medicine |
| Location | 1431 N Western Ave, Chicago, Illinois |
| Authorized Official Name and Position | Samuel Francisco Castillo (MEMBER) |
| Authorized Official Contact | 8477087496 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chicago Gi 1431 N Western Ave Suite 133 Chicago IL 60622-1797 Ph: (773) 342-6800 | Chicago Gi 1431 N Western Ave Suite 133 Chicago IL 60622-1797 Ph: (773) 342-6800 |
| NPI Number | 1366792426 |
|---|---|
| Provider Enumeration Date | 09/17/2012 |
| Last Update Date | 09/17/2012 |
| Medicare PECOS PAC ID | 6204077100 |
|---|---|
| Medicare Enrollment ID | O20130718000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366792426 | NPI | - | NPPES |
| 692861 | Other | IL | MEDICARE |
| 1205801313 | Other | IL | NPI |
| 036122662 | Medicaid | IL | |
| 036063975 | Medicaid | IL | |
| 1467503672 | Other | IL | NPI |
| I17297 | Other | IL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 248000667 (Illinois) | Primary |
| Provider Name | Samuel F Castillo |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1205801313 PECOS PAC ID: 1759340953 Enrollment ID: I20100119000769 |
| Provider Name | Samuel Castillo |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1467503672 PECOS PAC ID: 5193966000 Enrollment ID: I20130808000538 |
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