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General NPI Number Information
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NPI Number | 1154366680
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Entity Type | Individual
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Provider Name | RALPH M CARUSO DO
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 1225 E COOLSPRING AVE
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-6312
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Country | US
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Telephone | 219-873-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 E COOLSPRING AVE
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-6312
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Country | US
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Telephone | 219-873-2919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101010457
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02002151A
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License Number State | IN
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