Provider Demographics
NPI:1598763203
Name:CARUSO, JOSEPH MICHAEL (MD)
Entity Type:Individual
Prefix:DR
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 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4630 VISTULA RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-4000
Practice Address - Country:US
Practice Address - Phone:574-647-1900
Practice Address - Fax:574-647-7206
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035309A207PT0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100090740Medicaid
INP00105676OtherRR MEDICARE
IN000000201437OtherBCBS BMG E BLAIR WARNER
IN000000489649OtherBCBS MD PT IRELAND RD
IN100090740Medicaid
IN000000489649OtherBCBS MD PT IRELAND RD
IN236040E4Medicare PIN
IN100090740Medicaid
IN162520OOMedicare PIN