Provider Demographics
NPI:1245204841
Name:CARUSO, JOSEPH MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:CARUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1602
Mailing Address - Country:US
Mailing Address - Phone:303-549-9057
Mailing Address - Fax:303-993-6276
Practice Address - Street 1:1650 N GRANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1602
Practice Address - Country:US
Practice Address - Phone:303-549-9057
Practice Address - Fax:303-993-6276
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42486207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00151907OtherRR MEDICARE
CO86538870Medicaid
C534718Medicare PIN
COC804361Medicare PIN
P00151907OtherRR MEDICARE