Provider Demographics
NPI:1629095112
Name:CARUSO, MARK PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PETER
Last Name:CARUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7101 SW 99TH AVENUE
Mailing Address - Street 2:SUITE #108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-630-3300
Mailing Address - Fax:305-630-2558
Practice Address - Street 1:7101 SW 99TH AVENUE
Practice Address - Street 2:SUITE #108
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-630-3300
Practice Address - Fax:305-630-2558
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0039540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067489300Medicaid
FL96165Medicare ID - Type Unspecified
D64856Medicare UPIN