MEDICARE: DR. SAM CARUSO D.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
1	111N00000X	Chiropractor	2301005487	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950F35301	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932184827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAM CARUSO D.C.

Provider Business Mailing Address
First Line	:	25 S LAPEER ST
Second Line	:
City	:	LAKE ORION
State	:	MI
Zip	:	48362-3167
Country	:	US
Telephone Number	:	248-693-4800
Fax Number	:	248-693-3539

Provider Business Practice Location Address
First Line	:	25 S LAPEER ST
Second Line	:
City	:	LAKE ORION
State	:	MI
Zip	:	48362-3167
Country	:	US
Telephone Number	:	248-693-4800
Fax Number	:	248-693-3539

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	02/20/2017

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