MEDICARE: DR. JOSEPH MICHAEL CARUSO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PT0002X	Medical Toxicology (Emergency Medicine) Physician	01035309A	IN
2	207Q00000X	Family Medicine Physician	01035309A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598763203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH MICHAEL CARUSO M.D.

Provider Business Mailing Address
First Line	:	3245 HEALTH DR STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-1380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4630 VISTULA RD
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46544-4000
Country	:	US
Telephone Number	:	574-647-1900
Fax Number	:	574-647-7289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/26/2024

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