Provider Demographics
NPI:1477863819
Name:MARK P. CARUSO M.D.P.A.
Entity Type:Organization
Organization Name:MARK P. CARUSO M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-630-3300
Mailing Address - Street 1:7101 SW 99TH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4661
Mailing Address - Country:US
Mailing Address - Phone:305-630-3300
Mailing Address - Fax:
Practice Address - Street 1:7101 SW 99TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4661
Practice Address - Country:US
Practice Address - Phone:305-630-3300
Practice Address - Fax:305-630-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067489300Medicaid
FL067489300Medicaid