Basic Information
| Provider Information | |||||||||
| NPI: | 1598763203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARUSO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 N NILES AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466171924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746471610 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4630 VISTULA RD | ||||||||
| Address2: | |||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465444000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746471900 | ||||||||
| FaxNumber: | 5746477206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PT0002X | 01035309A | IN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Medical Toxicology |
ID Information
| ID | Type | State | Issuer | Description | 000000489651 | 01 | IN | BCBS BMG SCHWARTZ | OTHER | P00105676 | 01 | IN | RR MEDICARE | OTHER | 000000201437 | 01 | IN | BCBS BMG E BLAIR WARNER | OTHER | 000000489649 | 01 | IN | BCBS MD PT IRELAND RD | OTHER | 100090740 | 05 | IN | MEDICAID |