Healthcare Provider Details

I. General information

NPI: 1417938754
Provider Name (Legal Business Name): PAUL A. CARUSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LACEY ST
CAPE GIRARDEAU MO
63701-5230
US

IV. Provider business mailing address

1701 LACEY ST
CAPE GIRARDEAU MO
63701-5230
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-4822
  • Fax:
Mailing address:
  • Phone: 573-334-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberC51498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: