Healthcare Provider Details

I. General information

NPI: 1508139916
Provider Name (Legal Business Name): CHRISTIAN CARUSO PA, MPAS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S 27TH ST
BILLINGS MT
59101-4227
US

IV. Provider business mailing address

123 S 27TH ST
BILLINGS MT
59101-4227
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-3250
  • Fax: 406-247-3389
Mailing address:
  • Phone: 406-247-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number27877
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: