Provider Demographics
NPI:1053576686
Name:CASTROVILLARI, JOY (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:CASTROVILLARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:DULSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2001 N GARY AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3055
Mailing Address - Country:US
Mailing Address - Phone:630-653-5115
Mailing Address - Fax:630-653-4493
Practice Address - Street 1:2001 N GARY AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3055
Practice Address - Country:US
Practice Address - Phone:630-653-5115
Practice Address - Fax:630-653-4493
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 121171208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400098897OtherMEDICARE (INDIVIDUAL PTAN)
IL4532123OtherBCBS
IL36121171Medicaid
IL920540OtherMEDICARE (GROUP PTAN)