1922094317 NPI number — DR. MICHAEL GEORGE CARUSO MD

Table of content: DR. MICHAEL GEORGE CARUSO MD (NPI 1922094317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922094317 NPI number — DR. MICHAEL GEORGE CARUSO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARUSO
Provider First Name:
MICHAEL
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922094317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4002 SUN CITY CENTER BLVD
Provider Second Line Business Mailing Address:
UNIT 102
Provider Business Mailing Address City Name:
SUN CITY CENTER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33573-5208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-634-1455
Provider Business Mailing Address Fax Number:
813-642-8355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4002 SUN CITY CENTER BLVD
Provider Second Line Business Practice Location Address:
UNIT102
Provider Business Practice Location Address City Name:
SUN CITY CENTER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-634-1455
Provider Business Practice Location Address Fax Number:
813-642-8355
Provider Enumeration Date:
09/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  ME36579 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112236300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com