MEDICARE: MICHAEL G CARUSO MD PA

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	207N00000X	Dermatology Physician		FL

General Provider Information

NPI Number	:	1649266172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL G CARUSO MD PA

Provider Business Mailing Address
First Line	:	4002 SUN CITY CENTER BLVD
Second Line	:	UNIT 102
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5208
Country	:	US
Telephone Number	:	813-634-1455
Fax Number	:	813-642-8355

Provider Business Practice Location Address
First Line	:	4002 SUN CITY CENTER BLVD
Second Line	:	UNIT 102
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5208
Country	:	US
Telephone Number	:	813-634-1455
Fax Number	:	813-642-8355

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL G CARUSO
Credential	:	MD
Telephone Number	:	813-634-1455

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/04/2010

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