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1811630130 NPI number — OLGA CHRISTINA CARUSO DO

NPI Number: 1811630130
Health Care Provider/Practitioner: OLGA CHRISTINA CARUSO DO

Information about “1811630130” NPI (OLGA CHRISTINA CARUSO DO) exists in 1811630130 in HTML format HTML  |  1811630130 in plain Text format TXT  |  1811630130 in PDF (Portable Document Format) PDF  |  1811630130 in an XML format XML  formats.

NPI Number : 1811630130 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811630130",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CARUSO",
    "FirstName": "OLGA",
    "MiddleName": "CHRISTINA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "26901 BEAUMONT BLVD STE 3D",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48033-3849",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "17000 KERCHEVAL AVE STE 205",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GROSSE POINTE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48230-1570",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-640-2424",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2022",
    "LastUpdateDate": "10/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "04/14/2022",
    "NPIReactivationDate": "06/14/2022",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "5101028768",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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