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NPI Code Detail

MEDICARE: MR. MICHAEL JOSEPH LOUIS CAPORUSCIO PA-C

MEDICARE: MR. MICHAEL JOSEPH LOUIS CAPORUSCIO PA-C
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
1363AM0700XMedical Physician AssistantMI
2363A00000XPhysician Assistant5601013384MI

General Provider Information

NPI Number : 1700765195
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL JOSEPH LOUIS CAPORUSCIO PA-C
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 44201 DEQUINDRE RD
Second Line :
City : TROY
State : MI
Zip : 48085-1117
Country : US
Telephone Number : 248-964-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2025
Last Update Date : 12/12/2025

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