Provider Demographics
NPI:1174741409
Name:TRYSKA, KARISSA LEAH (DO)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:LEAH
Last Name:TRYSKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 428
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-672-3300
Practice Address - Fax:231-672-3380
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015747207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F110460OtherBLUE CROSS BLUE SHIELD
MI5204157Medicaid
MIKT015747OtherBLUE CARE NETWORK
MIN27830037Medicare PIN