Basic Information
| Provider Information | |||||||||
| NPI: | 1568549269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARUSO | ||||||||
| FirstName: | ALFRED | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 872332 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641872332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163896100 | ||||||||
| FaxNumber: | 8163896150 | ||||||||
| Practice Location | |||||||||
| Address1: | 1004 CARONDELET DR | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641144802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163896100 | ||||||||
| FaxNumber: | 8163896150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 04/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | R8H50 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 04-24867 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | R8H50 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 208944900 | 05 | MO | MEDICAID | 100333270C | 05 | KS | MEDICAID | 14429021 | 01 | MO | BCBS OF KC | OTHER | 1568549269 | 05 | MO | MEDICAID |