Provider Demographics
NPI:1558596015
Name:CARUSO, JENNIFER KRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KRISTINE
Last Name:CARUSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22255 GREENFIELD RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3710
Mailing Address - Country:US
Mailing Address - Phone:248-849-2710
Mailing Address - Fax:248-849-4024
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:SUITE 350
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:248-849-2710
Practice Address - Fax:248-849-4024
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018168207V00000X, 207VM0101X
PAOS016329207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30152919OtherAMERIHEALTH CARITAS, PA - WMG - THFPC
PA30152902OtherAMERIHEALTH CARITAS, PA - YH OB TEACHING
PA30153192OtherAMERIHEALTH CARITAS, PA - WMG - WS YORK HOSP OB/GYN
PA420140OtherUPMC
PA30153194OtherAMERIHEALTH CARITAS, PA - WMG - MATERNAL FETAL MED.
PA1622982OtherGATEWAY
PA30153197OtherAMERIHEALTH CARITAS, PA - WMG - YWHC
MD065773500Medicaid
PA102804570Medicaid
PA2884237OtherHIGHMARK BLUE SHIELD
PA30152919OtherAMERIHEALTH CARITAS, PA - WMG - THFPC
PA30153197OtherAMERIHEALTH CARITAS, PA - WMG - YWHC