MEDICARE: DR. JAMES M CARUSO MD

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	207Q00000X	Family Medicine Physician	036082576	IL

General Provider Information

NPI Number	:	1275524449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M CARUSO MD

Provider Business Mailing Address
First Line	:	2408 SHAKER CT
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8449
Country	:	US
Telephone Number	:	630-922-4155
Fax Number	:

Provider Business Practice Location Address
First Line	:	4939 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2505
Country	:	US
Telephone Number	:	630-922-4155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	04/05/2016

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