Provider Demographics
NPI:1144243221
Name:MACALUSO, THOMAS HENRY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HENRY
Last Name:MACALUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4600 SHERIDAN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3409
Mailing Address - Country:US
Mailing Address - Phone:954-989-3600
Mailing Address - Fax:954-894-1884
Practice Address - Street 1:4600 SHERIDAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3409
Practice Address - Country:US
Practice Address - Phone:954-989-3600
Practice Address - Fax:954-894-1884
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME619642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE92954Medicare UPIN
FL15067Medicare ID - Type Unspecified