| Entity Name: | MARK P. CARUSO, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 24 Oct 2001 (23 years ago) |
| Document Number: | P01000102951 |
| FEI/EIN Number | 651151700 |
| Address: | 7101 S.W.99TH AVENUE, SUITE 108, MIAMI, FL, 33173-4661 |
| Mail Address: | 7101 S.W.99TH AVENUE, SUITE 108, MIAMI, FL, 33173-4661 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477863819 | 2010-10-19 | 2010-10-19 | 7101 SW 99TH AVE, SUITE 108, MIAMI, FL, 331734661, US | 7101 SW 99TH AVE, SUITE 108, MIAMI, FL, 331734661, US | |||||||||||||||||||||||||
|
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| Phone | +1 305-630-3300 |
| Fax | 3056302558 |
Authorized person
| Name | DR. MARK PETER CARUSO |
| Role | PRESIDENT |
| Phone | 3056303300 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME0039540 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 067489300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARUSO MARK P | Agent | 7101 S.W.99TH AVENUE, MIAMI, FL, 331734661 |
| Name | Role | Address |
|---|---|---|
| CARUSO MARK P | Director | 7101 S.W.99TH AVENUE SUITE 108, MIAMI, FL, 331734661 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
