Provider Demographics
NPI:1568549269
Name:CARUSO, ALFRED C (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:C
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:PO BOX 872332
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-2332
Mailing Address - Country:US
Mailing Address - Phone:816-389-6100
Mailing Address - Fax:816-389-6150
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:SUITE 410
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4802
Practice Address - Country:US
Practice Address - Phone:816-389-6100
Practice Address - Fax:816-389-6150
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8H50207RP1001X, 207RS0012X
KS04-24867207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208944900Medicaid
KS100333270CMedicaid
MO14429021OtherBCBS OF KC
MO1568549269Medicaid
MOMA1922008Medicare PIN
MO208944900Medicaid
KSKA2102001Medicare PIN
KS130758003Medicare UPIN
MOY36000046Medicare PIN
KSKA2102001Medicare PIN