Provider Demographics
NPI:1376652131
Name:CARAKUSHANSKY, MAURI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURI
Middle Name:
Last Name:CARAKUSHANSKY
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:115 COLUMBIA ST
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1046
Practice Address - Country:US
Practice Address - Phone:407-650-7210
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME887602080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268367900Medicaid
FL268367900Medicaid
81603ZMedicare ID - Type Unspecified