Provider Demographics
NPI:1619330826
Name:J. MICHAEL CARUSO, MD, FACEP, L.L.C.
Entity Type:Organization
Organization Name:J. MICHAEL CARUSO, MD, FACEP, L.L.C.
Other - Org Name:HYPER REAL BEAUTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-204-9674
Mailing Address - Street 1:1650 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1602
Mailing Address - Country:US
Mailing Address - Phone:303-549-9057
Mailing Address - Fax:303-993-6276
Practice Address - Street 1:1650 N GRANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1602
Practice Address - Country:US
Practice Address - Phone:303-549-9057
Practice Address - Fax:303-993-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42486261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service