Basic Information
| Provider Information | |||||||||
| NPI: | 1558596015 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARUSO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | KRISTINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22255 GREENFIELD RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480753710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488492710 | ||||||||
| FaxNumber: | 2488494024 | ||||||||
| Practice Location | |||||||||
| Address1: | 22255 GREENFIELD RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480753710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488492710 | ||||||||
| FaxNumber: | 2488494024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2009 | ||||||||
| LastUpdateDate: | 08/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5101018168 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | OS016329 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | 5101018168 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30152919 | 01 | PA | AMERIHEALTH CARITAS, PA - WMG - THFPC | OTHER | 30152902 | 01 | PA | AMERIHEALTH CARITAS, PA - YH OB TEACHING | OTHER | 30153192 | 01 | PA | AMERIHEALTH CARITAS, PA - WMG - WS YORK HOSP OB/GYN | OTHER | 420140 | 01 | PA | UPMC | OTHER | 30153194 | 01 | PA | AMERIHEALTH CARITAS, PA - WMG - MATERNAL FETAL MED. | OTHER | 1622982 | 01 | PA | GATEWAY | OTHER | 30153197 | 01 | PA | AMERIHEALTH CARITAS, PA - WMG - YWHC | OTHER | 065773500 | 05 | MD | MEDICAID | 102804570 | 05 | PA | MEDICAID | 2884237 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |