Provider Demographics
NPI:1649201385
Name:MACALUSO, ANTHONY JR (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MACALUSO
Suffix:JR
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 1:11551 FOREST CENTRAL DR
Mailing Address - Street 2:SUITE 133
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3920
Mailing Address - Country:US
Mailing Address - Phone:214-348-5288
Mailing Address - Fax:214-343-3689
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE A-321
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-661-3575
Practice Address - Fax:972-233-9120
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6556208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042702301Medicaid
TX042702302Medicaid
TXG89327Medicare UPIN